Competition License Application This application is intended for those with prior racing experience who are new to RMVR and plan on racing regularly with us as a member. If you plan on gaining your Competition License by attending the RMVR Spring Drivers’ School, please register for Drivers' School rather than filling out this application. Guests with a valid competition license from other VMC clubs need not apply for an RMVR license. The license from your home VMC club will suffice. Simply provide your current competition license info when you enter our event. Current RMVR members with a valid competition license need not re-apply—your license will be re-issued when you renew your membership and submit a current medical. Name* First Last Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Address* Enter Email Confirm Email Home PhoneOffice PhoneCell PhoneAre you currently an RMVR member in good standing?* Yes No In addition to this form, please submit an Application for Membership.Have you ever had an RMVR Competition License?* Yes No In what year did your license expire?*2017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990For how many years did you have your previous license?*1234567891011121314151617181920>20What was your license number?* Have you ever had a valid Competition License from another racing organization?* Yes No From what club?* License number?* Expiration Date?* MM slash DD slash YYYY Has your Competition License ever been revoked or suspended?* Yes No Date revoked or suspended?* MM slash DD slash YYYY Why was your license revoked or suspended?*Do you have a current racing medical exam?* Yes, on file with RMVR Yes, with another organization No You will need to provide a completed Medical Form in support of your application for a Competition License. Please mail to the RMVR administrator at: Rocky Mountain Vintage Racing, 1376 Columbine Drive Franktown, CO 80116When does your medical expire?* MM slash DD slash YYYY Please provide a scanned copy of your current racing medical exam:Max. file size: 256 MB.You can also mail a copy of your current exam to the RMVR administrator at: Rocky Mountain Vintage Racing, 1376 Columbine Drive, Franktown, CO 80116Please list any Racing Schools you have attended (with dates):*Please list all racing experience, including club racing, and types of cars raced:*When was your last race or competition? MM slash DD slash YYYY Δ
