Out-of-Province Race Result Verification Form

Ontario
Association
OntarioCycling
Cycling Association
Phone:
416-855-1717
905-636-9594
Phone:
(416) 426-7416 Fax:
Fax: (416)
426-7349
3 Concorde
Gate,
Suite 212 Suite,
Toronto,Milton,
ON M3CON
3N7 L9T 8Y9
E-mail:
info@ontariocycling.org
2-2015
Pan Am
Boulevard
Email:
events@ontariocycling.org
Out-of-Province Race Result Verification Form
This form is applicable for sanctioned races in the U.S.A. or Canada.
Fill in the top section of the form completely and clearly. Present it along with your racing licence to the chief
commissaire of the event and have him/her complete the bottom section.
This form must be returned to the OCA office ASAP. Forms that are received more than one month after the event
date will not be accepted. Note all decisions on awarding points are subject to the approval of the Ontario Cycling
Association.
Please Print Clearly
Name of Rider
License Number
Name of Race
Race Type (Road, Crit, TT)
OCA Licence Category
Date of Event
Distance
Categories in the race (what categories were in the race you rode)
A licensed CCA commissaire or USAC official must complete this section.
This form will be used to assign upgrading points for this rider. Please fill in the placing of the rider. Do not sign the
form unless the top portion is complete and verify the identity of the rider by examining his/her racing license. Thank
you for your cooperation.
I certify that I was a working commissaire/official at the stated event and that the above named rider competed and
placed _____________ in this event and that the information supplied on this form is correct.
Official Signature: ____________________________________________
Officials Name (Please Print): _______________________________________________
Officials License Number: ____________________