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NATIONAL & INTERNATIONAL EVENTS / VNEMENTS NATIONAUX ET INTERNATIONAUX
- Cyclocross-
Please, complete this form by answering all questions. (Digital format mandatory)
Veuillez complter ce formulaire en rpondant toutes les questions. (Format lectronique obligatoire)
Keep a copy of this document for your files.
Veuillez en conserver un exemplaire pour vos dossiers.
Incomplete applications will not be considered.
Une application incomplte ne sera pas considre.
The application m u s t b e r e t u r n e d t o t h e C C A p r i o r t o t h e d e a d l i n e .
L a p p l i c a t i o n d o i t t r e r e t o u r n e a u b u r e a u d e l ' A C C a v a n t l a d a t e l i m i t e f i x e .
O R G A N I Z E R / O R G A N I S A T E U R R e s p o n s i b l e e n t i t y
E n t i t r e s p o n s a b l e F O R M T E X T R e s p o n s i b l e p e r s o n
P e r s o n n e r e s p o n s a b l e F O R M T E X T A d d r e s s / A d r e s s e F O R M T E X T F O R M T E X T P o s t a l c o d e / C o d e p o s t a l F O R M T E X T P h o n e / T l p h o n e F O R M T E X T ( H / M ) F O R M T E X T ( W / T ) F a x / T l c o p i e u r F O R M T E X T E m a i l / C o u r r i e l F O R M T E X T W e b s i t e / S i t e i n t e r n e t F O R M T E X T O r g a n i z e r s U C I c o d e
C o d e U C I d e l o r g a n i s a t e u r F O R M T E X T L i c e n s e n u m b e r
N u m r o d e l i c e n c e F O R M T E X T
L e g e n d / L g e n d e
L e v e l o f s a n c t i o n / N i v e a u d e s a n c t i o n
P o i n t s D e s c r i p t i o n U C I * N R / C N * * U C I C N N a t i o n a l C h a m p i o n s h i p / C h a m p i o n n a t n a t i o n a l F O R M C H E C K B O X F O R M C H E C K B O X U C I 2 C l a s s 2 I n t e r n a t i o n a l R a c e / C o u r s e internationale classe 2 FORMCHECKBOX FORMCHECKBOX UCI 1Class 1 International Race / Course internationale classe 1 FORMCHECKBOX FORMCHECKBOX UCI CCContinental Championship / Championnat continental FORMCHECKBOX UCI WCWorld Cup / Coupe du monde FORMCHECKBOX FORMCHECKBOX UCI WchWorld Championship / Championnat du monde FORMCHECKBOX * Only for Junior, U23 and Elite riders / Seulement pour les coureurs junior, U23 & lite
** National Ranking - Only for Junior, U23 and Elite riders
Classement national - Seulement pour les coureurs junior, U23 & lite
Category / Catgorie
MJJunior Men / Junior hommeWM 30 +Master Women 30 + / Matre femme 30 +MUUnder 23 Men / Moins 23 hommeMM 30-39Master Men 30-39 / Matre homme 30-39WEJunior & Elite Women / Junior & lite femmeMM 40-49Master Men 40-49 / Matre homme 40-49MEElite Men / lite hommeMM 50 +Master Men 50 + / Matre homme 50 +
GENERAL INFO / INFORMATION GNRALESName of event / Nom de lv n e m e n t F O R M T E X T L e v e l o f s a n c t i o n / N i v e a u d e s a n c t i o n F O R M C H E C K B O X U C I C N F O R M C H E C K B O X U C I 2 F O R M C H E C K B O X U C I 1 F O R M C H E C K B O X U C I C C F O R M C H E C K B O X U C I W C F O R M C H E C K B O X U C I W c h - m a s t e r F O R M C H E C K B O X U C I Wch Junior/U23/EliteCategories / Catgories FORMCHECKBOX MJ FORMCHECKBOX MU FORMCHECKBOX WE FORMCHECKBOX ME FORMCHECKBOX WM 30 + FORMCHECKBOX MM 30-39 FORMCHECKBOX MM 40-49 FORMCHECKBOX MM 50 +Date selection / Slection de la date FORMTEXT 1 s t c h o i c e
1 e r c h o i x F O R M T E X T 2 n d c h o i c e
2 m e c h o i x
H O S T I N G C A P A C I T Y / C A P A C I T D A C C U E I L H o s t C i t y / V i l l e h t e F O R M T E X T P o p u l a t i o n F O R M T E X T C l o s e s t m a j o r c i t y
V i l l e m a j e u r e l a p l u s p r o c h e F O R M T E X T P o p u l a t i o n F O R M T E X T N e a r e s t a i r p o r t
A r o p o r t l e p l u s p r s F O R M T E X T N e a r e s t m a j o r i n t e r n a t i o n a l a i r p o r t
A r o p o r t i n t e r n a t i o n a l m a j e u r l e p l u s p r s F O R M T E X T D i s t a n c e f r o m t h e c l o s e s t m a j o r c i t y t o r a c e s i t e
D i s t a n c e d e l a v i l l e m a j e u r e l a p l u s p r o c h e a u s i t e d e c o u r s e K M F O R M T E X T D i s t a n c e f r o m r a c e s i t e t o t h e n e a r e s t a i r p o r t
D i s t a n c e d u s i t e d e c o u r s e l a r o p o r t l e p l u s p r o c h e K M F O R M T E X T D i s t a n c e f r o m r a c e s i t e t o t h e n e a r e s t m a j o r i n t e r n a t i o n a l a i r p o r t
D i s t a n c e d u s i t e d e c o u r s e l a r o p o r t i n t e r n a t i o n a l m a j e u r l e p l u s p r o c h e K M F O R M T E X T N u m b e r o f b e d s a v a i l a b l e o n r a c e s i t e
N o m b r e d u n i t d e l o g e m e n t d i s p o n i b l e s s u r l e s i t e d e c o u r s e : F O R M T E X T N u m b e r o f b e d s a v a i l a b l e i n a 1 0 k m r a d i u s o f t h e r a c e s i t e
N o m b r e d u n i t d e l o g e m e n t d i s p o n i b l e s d a n s u n r a y o n d e 1 0 k m d u s i t e d e c o u r s e F O R M T E X T D o y o u h a v e a r e s t a u r a n t a v a i l a b l e o n r a c e s i t e ?
A v e z - v o u s u n r e s t a u r a n t d i s p o n i b l e s u r l e s i t e d e c o u r s e ? F O R M C H E C K B O X Y / O F O R M C H E C K B O X N / N N u m b e r o f d i n i n g t a b l e s a v a i l a b l e i n a 1 0 k m r a d i u s o f r a c e s i t e
N o m b r e d e t a b l e s d i s p o n i b l e s d a n s u n r a y o n d e 1 0 k m d u s i t e d e c o u r s e F O R M T E X T P a r k i n g c a p a c i t y a t r a c e s i t e
C a p a c i t d e s t a t i o n n e m e n t a u s i t e d e c o u r s e F O R M T E X T S p e c t a t o r c a p a c i t y a t r a c e s i t e
C a p a c i t d e s p e c t a t e u r s a u s i t e d e c o u r s e F O R M T E X T P u b l i c t r a n s p o r t a t i o n a v a i l a b l e t o r e a c h r a c e s i t e f r o m t h e h o s t c i t y
S e r v i c e s d e t r a n s p o r t p u b l i c disponible pour atteindre le site de divers points de la ville hte FORMCHECKBOX Bus / Autobus FORMCHECKBOX Taxi FORMCHECKBOX Train FORMCHECKBOX Car rental / Location auto FORMCHECKBOX Shuttle / Navette
ORGANIZING CAPACITIES / CAPACIT DORGANISATIONHuman Resources / Ressources humainesTotal club members, organization volunteers age 16 and over
Nombre total de membres du club, bnvoles de lorganisation ayant 16 ans et plus FORMTEXT
C a t e g o r y / C a t g o r i e D i s t a n c e c i r c u i t ( K M ) D i s t a n c e
T o t a l
( K M ) M J F O R M T E X T F O R M T E X T M U F O R M T E X T F O R M T E X T W E F O R M T E X T F O R M T E X T M E F O R M T E X T F O R M T E X T W M 3 0 + F O R M T E X T F O R M T E X T M M 3 0 - 3 9 F O R M T E X T F O R M T E X T M M 4 0 - 4 9 F O R M T E X T F O R M T E X T M M 5 0 + F O R M T E X T F O R M T E X T
P l e a s e i n s e r t c o u r s e m a p h e r e / s v p i n s r e r l e p l a n d u p a r c o u r s ici
Utilities / UtilitsElectricity at the start / lectricit au dpart FORMCHECKBOX Y/O FORMCHECKBOX N/NElectricity at the finish line / lectricit larrive FORMCHECKBOX Y/O FORMCHECKBOX N/NTiming cable at the start / Cble chrono au dpart FORMCHECKBOX Y/O FORMCHECKBOX N/NTiming cable at the finish / Cble chrono larrive FORMCHECKBOX Y/O FORMCHECKBOX N/NPhoto-finish available / Photo-finish disponible FORMCHECKBOX Y/O FORMCHECKBOX N/NPA system available / Systme de son disponible FORMCHECKBOX Y/O FORMCHECKBOX N/NWireless internet available in S/F area / Internet sans fil disponible dans la zone de D/A FORMCHECKBOX Y/O FORMCHECKBOX N/NCrowd control barricades available / Clture de contrle de foule disponible (400 m min.) FORMCHECKBOX Y/O FORMCHECKBOX N/NCourse signage available / Signalisation de parcours disponible FORMCHECKBOX Y/O FORMCHECKBOX N/NRadio Tour in place for the race / Radio Tour en place pour la course FORMCHECKBOX Y/O FORMCHECKBOX N/N
FinancesPlease, complete or insert your detail event budget
SVP, compltez ou insrez votre budget dtaill de lvnementRevenuesCash /
ArgentValue in Kind /
Valeur en produitFederal Funding / Fonds fdraux FORMTEXT F O R M T E X T P r o v i n c i a l F u n d i n g / F o n d s p r o v i n c i a u x F O R M T E X T F O R M T E X T M u n i c i p a l F u n d i n g / F o n d s m u n i c i p a u x F O R M T E X T F O R M T E X T C o r p o r a t e F u n d i n g / F o n d s c o r p o r a t i f s F O R M T E X T F O R M T E X T R e g i s t r a t i o n s / I n s c r i p t i o n s F O R M T E X T F O R M T E X T O t h e r s / A u t r e s F O R M T E X T F O R M T E X T T o t a l F O R M T E X T F O R M T E X T E x p e n s e s / D p e n s e s C a s h /
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l a p ytC@ / M a t r i e l s d e c o u r s e s F O R M T E X T F O R M T E X T R a c i n g S e r v i c e s / S e r v i c e s c o u r s e F O R M T E X T F O R M T E X T P r o m o t i o n F O R M T E X T F O R M T E X T O t h e r s / A u t r e s F O R M T E X T F O R M T E X T T o t a l F O R M T E X T F O R M T E X T P r o f i t / l o s s P r o f i t / P e r t e s F O R M T E X T F O R M T E X T
T h e a t t a c h m e n t s / L e s i n s e r t i o n s T h e f o l l o w i n g i t e m s m u s t b e s u b m i t t e d w i t h t h e a p p l i c a t i o n f o r m
L e s i t e m s s u i v a n t s d o i v e n t t r e s o u m i s a v e c l a p p l i c a t i o n A t t a c h m e n t s / I n s e r t i o n s L i s t o f c o r p o r a t e s p o n s o r s f o r t h e e v e n t ( F o r C C A a p p r o v a l )
L i s t e d e s p a r t e n a i r e s c o r p o r a t i f s d e l v n e m e n t ( P o u r a p p r o b a t i o n d e l A C C )
H i s t o r y o f t h e o r g a n i z i n g c o m m i t t e e i n c y c l i n g e v e n t o r g a n i z a t i o n ( a l l d i s c i p l i n e s )
H i s t o r i q u e d e l o r g a n i s a t i o n e n m a t i r e d o r g a n i s a t i o n d v n e m e n t c y c l i s t e ( t o u t e d i s c i p l i n e )
A c o p y o f t h e p r o p o s e d s c h e d u l e ( F o r C C A a p p r o v a l )
U n e c o p i e d e l h o r a i r e d e l v n e m e n t p r o p o s ( P o u r a p p r o b a t i o n d e l A C C )
P r o f i l e a n d t o p o g r a p h y o f t h e c o u r s e o r t r a c k ( d i s t a n c e , f e a t u r e s , p i c t u r e s , e t c . )
P r o f i l e t t o p o g r a p h i e d e l a p i s t e o u d u p a r c o u r s ( d i s t a n c e , o b s t a c l e s , p h o t o s , e t c . )
L a y o u t o f t h e s t a r t a n d f i n i s h a r e a
D i a g r a m m e d e l a i r e d e d p a r t e t d a r r i v e
A c o p y o r y o u r U C I l i c e n s e
U n e c o p i e d e v o t r e l i c e n c e U C I
A c o p y o f y o u r i n s u r a n c e c e r t i f i c a t e f o r l i a b i l i t y c o v e r a g e ( m i n i m u m 5 m i l i o n s )
U n e c o p i e d e v o t r e p o l i c e d a s s u r a n c e s r e s p o n s a b i l i t c i v i l e ( m i n i m u m 5 m i l i o n s )
E x e c u t i v e C o m m i t t e e i n f o r m a t i o n l i s t ( n a m e , p h o n e , e m a i l ) a c c o r d i n g t o t h e a p p l i c a t i o n d o c u m e n t
L a l i s t e d u C o m i t E x c u t i f ( n o m , t l p h o n e , c o u r r i e l ) s e l o n l e d o c u m e n t d i n s c r i p t i o n
O r g a n i z i n g C o m m i t t e e c h a r t a c c o r d i n g t o t h e a p p l i c a t i o n d o c u m e n t
L o r g a n i g r a m m e d u C o m i t d o r g a n i s a t i o n s e l o n l e d o c u m e n t d i n s c r i p t i o n
L i s t o f f a c i l i t i e s i n f o r m a t i o n ( l o c a t i o n , t y p e , s i z e ) a c c o r d i n g t o t h e a p p l i c a t i o n d o c u m e n t
L a l i s t e d e s f a c i l i t e s ( e n d r o i t , t y p e , d i m e n s i o n ) s e l o n l e d o c u m e n t d i n s c r i p t i o n
L i s t o f e q u i p m e n t a v a i l a b l e ( t y p e , q u a n t i t y ) a c c o r d i n g t o t h e a p p l i c a t i o n d o c u m e n t
L a l i s t e d e s q u i p e m e n t s ( t y p e , q u a n t i t ) s e l o n l e d o c u m e n t d i n s c r i p t i o n
L i s t o f e n d o r s e m e n t a s r e q u i r e d i n t h e a p p l i c a t i o n d o c u m e n t
L a l i s t e d e s a p p u i s r e q u i s s e l o n l e d o c u m e n t d i n s c r i p t i o n
D E C L A R A T I O N / D C L A R A T I O N
A s r a c e o r g a n i z e r , I a m r e s p o n s i b l e f o r t h e t e c h n i c a l , o r g a n i z a t i o n a l , s a f e t y a n d f i n a n c i a l s t a n d a r d s o f t h i s e v e n t s a n c t i o n e d b y t h e U n i o n C y c l i s t e I n t e r n a t i o n a l e ( U C I ) a n d / o r t h e C a n a d i a n C y c l i n g A s s o c i a t i o n ( C C A ) .
I w i l l p a y a l l f e e s r e l a t e d t o t h e l e v e l o f s a n c t i o n o f t h e e v e n t , a c c o r d i n g t o t h e v a r i o u s o b l i g a t i o n s p u t i n p l a c e b y t h e U C I a n d / o r t h e C C A .
I u n d e r s t a n d t h a t I m u s t r e s p e c t g o v e r n m e n t s p o r t p o l i c i e s r e g a r d i n g b i l i n g u a l i s m , e q u i t y a n d s p o n s o r s h i p ( a c o p y o f t h i s p o l i c y i s a v a i l a b l e t h r o u g h t h e C C A ) .
I h a v e r e a d a n d u n d e r s t o o d t h e U C I a n d / o r C C A r u l e s a n d o b l i g a t i o n s , a n d I w i l l a p p l y t h e m i n g o o d f a i t h .
I w i l l p r o v i d e t o t h e C C A a l l i n f o r m a t i o n r e q u e s t e d i n t h i s a p p l i c a t i o n f o r m .
I w i l l p r o v i d e a w r i t t e n r e p o r t n o l a t e r t h a n o n e m o n t h a f t e r t h e c o m p l e t i o n o f t h e e v e n t
t i t r e d ' o r g a n i s a t e u r , j e s u i s r e s p o n s a b l e d e s n o r m e s t e c h n i q u e s , o r g a n i s a t i o n n e l l e s , s c u r i t a i r e s e t f i n a n c i r e s r e l i e s c e t t e p r e u v e s a n c t i o n n e p a r l U n i o n C y c l i s t e I n t e r n a t i o n a l e ( U C I ) e t / o u l ' A s s o c i a t i o n c y c l i s t e c a n a d i e n n e ( A C C ) .
J e m e n g a g e p a y t o u s l e s f r a i s , e n l i e n a v e c l e n i v e a u d e s a n c t i o n d e l v n e m e n t , s e l o n l e s d i f f r e n t e s o b l i g a t i o n s m i s e e n p l a c e p a r l A C C e t / o u l U C I .
J e c o m p r e n d s q u e j e d o i s r e s p e c t e r l e s p o l i t i q u e s s p o r t i v e s o f f i c i e l l e s d u g o u v e r n e m e n t c a n a d i e n c o n c e r n a n t l e b i l i n g u i s m e , l g a l i t e n t r e l e s s e x e s e t l a c o m m a n d i t e . ( C o p i e d i s p o n i b l e a u b u r e a u d e l A C C )
J a i p r i s c o n n a i s s a n c e e t j e c o m p r e n d s l e s r g l e m e n t s e t l e s o b l i g a t i o n s d e l A C C e t / o u d e l ' U C I e t j e c o n s e n s l e s a p p l i q u e r e n b o n n e e t d f o r m e .
J e f o u r n i r a i l A C C t o u t e s l e s i n f o r m a t i o n s d e m a n d e s d a n s c e f o r m u l a i r e d a p p l i c a t i o n .
J e s o u m e t t r a i l A C C u n r a p p o r t c o m p l e t c r i t l a f i n d e l v n e m e n t d a n s u n d l a i d a u p l u s u n m o i s .
F O R M T E X T O r g a n i z e r n a m e / N o m d e l ' o r g a n i s a t e u r S i g n a t u r e F O R M T E X T D a t e
2 1 9 7 R i v e r s i d e D r i v e , s u i t e 2 0 3 , O t t a w a , O n t a r i o , K 1 H 7 X 3
T e l : 6 1 3 - 2 4 8 - 1 3 5 3 F a x : 6 1 3 2 4 8 9 3 1 1
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