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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Email *
Surname *
Forenames
*
Address Line 1
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Address Line 2
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Postal Code
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Country
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Ride 1 Organizing Club / Ride Name
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Ride 1 Distance
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Ride  1 Date
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MM
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DD
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YYYY
Ride 1 Country
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Ride 1 Homologation Number
*
Ride 2 Organizing Club / Ride Name
*
Ride 2 Distance
*
Ride 2 Date
*
MM
/
DD
/
YYYY
Ride 2 Country
*
Ride 2 Homologation Number
*
Ride 3 Organizing Club / Ride Name
*
Ride 3 Distance
*
Ride 3 Date
*
MM
/
DD
/
YYYY
Ride 3 Country
*
Ride 3 Homologation Number
*
Ride 4 Organizing Club / Ride Name
*
Ride 4 Distance
*
Ride 4 Date
*
MM
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DD
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YYYY
Ride 4 Country
*
Ride 4 Homologation Number
*
I certify that I have completed the rides in accordance with the rules applicable to LRM or BRM events
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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. *
A copy of your responses will be emailed to the address you provided.
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