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: ____________________