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International Super Randonneur Application
The completed form will be sent to Dave Thompson by email with a copy to you. If you want the completed brevet card and patch, please use PayPal to send a payment of $10 US to isr@pobox.com. If you are unable to use PayPal or have other questions, contact Dave at isr@pobox.com.
Elevated awards for distance and continents will be automatically applied.
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* Indicates required question
Email
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Your email
Surname
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Your answer
Forenames
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Your answer
Address Line 1
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Your answer
Address Line 2
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Your answer
Postal Code
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Your answer
Country
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Your answer
Ride 1 Organizing Club / Ride Name
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Your answer
Ride 1 Distance
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Your answer
Ride 1 Date
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MM
/
DD
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YYYY
Ride 1 Country
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Your answer
Ride 1 Homologation Number
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Your answer
Ride 2 Organizing Club / Ride Name
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Your answer
Ride 2 Distance
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Your answer
Ride 2 Date
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MM
/
DD
/
YYYY
Ride 2 Country
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Your answer
Ride 2 Homologation Number
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Your answer
Ride 3 Organizing Club / Ride Name
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Your answer
Ride 3 Distance
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Your answer
Ride 3 Date
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MM
/
DD
/
YYYY
Ride 3 Country
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Your answer
Ride 3 Homologation Number
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Your answer
Ride 4 Organizing Club / Ride Name
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Your answer
Ride 4 Distance
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Your answer
Ride 4 Date
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MM
/
DD
/
YYYY
Ride 4 Country
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Your answer
Ride 4 Homologation Number
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Your answer
I certify that I have completed the rides in accordance with the rules applicable to LRM or BRM events
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Yes
Required
Do you want a brevet card and patch? If yes, please send $10 USD via PayPal to isr@pobox.com. If no, I will review the submission and update the list of awardees.
*
Yes, I want a patch and brevet card. I will send $10 USD to
isr@pobox.com
.
No, I do not want or need a patch or brevet card.
A copy of your responses will be emailed to the address you provided.
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