Application Form
It’s time to recognize the very best of the best!
Where: Las Vegas Convention Center in Las Vegas, Nevada
When: Wednesday, March 5, 2014 @ 8:00 a.m.
Who is Eligible to Apply?
1. Winners of NRMCA’s National Mixer Driver Championship:
All of the top three winners from 2011 through 2013 of NRMCA’s National Mixer Driver Championship are eligible to apply.
2. International Drivers
Drivers from outside the US are eligible to apply. The number of International drivers will be limited to twenty five.
3. “At-Large” Entrants:
NRMCA will accept a limited number of “at large” entrants for the competition. The number of at-large entrants accepted will be based on the need to fill out the field of contestants. NRMCA reserves the right to determine number of entrants.
4. No Driver, Regardless of qualifications is guaranteed eligibility:
NRMCA reserves the right to qualify or disqualify NMDC applicants at the Eligibility Review Panel’s discretion. All entries not accepted will receive a full application fee refund.
Deadlines and Dates:
Application forms for the 2014 NRMCA’s International Mixer Driver Championship are due by Friday, January 31, 2014. Entrants will be notified by Wednesday, February 5, 2014 and official invitations will be sent. Invitees must complete an application form and return it to NRMCA, along with their $325 entry fee. In early February, contestants will receive final instructions including a complete in-depth overview of the event and a map of the Challenge Course. Companies are responsible for their driver’s travel and lodging expenses in Las Vegas, Nevada. Any applicant that is not accepted will receive a full refund of application fee.
Entry Fee:
An entry fee of $325 is due with the application form on or before Friday, January 31, 2014.
NRMCA’s International Mixer Driver Championship Application
Driver’s Name: Badge Name:
Company:
Driver’s Work Address:
City: State: Zip:
Phone: Fax: __ E-mail address: ______
Supervisor’s Name:
Company:
Supervisor’s Work Address:
City: State: Zip:
Phone: Fax: __ E-mail address: ______
Emergency Contact/Relationship & Cell Phone:
Special Needs: ______
Payment must accompany registration…Due On or Before, Friday, January 31, 2014
Driver 1 @ $325.00 = $325.00
TOTAL DUE: $325.00
Payment Method:
American Express ______Master Card ______VISA ______
Card Number: Exp. Date:
Name on Credit Card (print):
Signature for Credit Card:
(If payment is made by check please mail to: NRMCA c/o Karen Bean, 900 Spring Street, Silver Spring, MD 20910)
Application forms received incomplete and without payment will not be processed.
EMAIL FORM WITH PaYMENT information TO: