License Application

Applicant Info

Name*

First Middle Last

Address*

Street Address City Province Postal Code

Email Address*

Are you an Area 27 Member?*

Yes

No

Area 27 Membership Number*

Home Phone

Cell Phone

Emergency Contact*

Emergency Contact Phone*

Date of Birth*

Sex*

Male

Female

Other

Business Name

Business Phone

Driver's License Number*

Province*

Expiry*

License Type*

Driver Qualifications*

Please list all previous performance driving experience and accreditation. The information provided will support your application being approved by ORRA 27. Applications with insufficient information will be declined.

Applicant's Declaration

I declare the information above is accurate and, upon issuance of any ORRA licence, I agree to abide by and observe the applicable rules as outlined in the ORRA Rules & Regulations document and any other applicable regulations under penalty of Suspension or Revocation at ORRA’s sole discretion.
I declare that the information regarding my present state of health, as given to physician is correct
I agree to be re-examined as follows:
1. Upon the expiration of my current medical as required by the current competition rules
2. Following any signicant illness, injury or hospitalization.
I give permission to any hospital, institution or physician to furnish my medical information to ORRA

Applicant's Signature*

Date*

Signature of Parent/Guardian (if under 18 years old)

Date

Please note, submission and payment of an application does not guarantee the applicant will be issued a license. Applicants must meet all qualifications prior to being granted a license. Applicants that do not meet the requirements for their respective license will be declined and the application fees will be returned.

Total

Credit Card

Card Details

Cardholder Name

Terms & Conditions*

I declare the information above is accurate and, upon issuance of any ORRA licence, I agree to abide by and observe the applicable rules as outlined in the ORRA Rules & Regulations document and any other applicable regulations under penalty of Suspension or Revocation at ORRA's sole discretion.

License Application

Applicant Info

Applicant's Medical Self-Declaration

Applicant's Declaration