Horse Racing Licensing Application Form

Horse Racing Licensing Application Form
Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Type of license applied for
Have you been found guilty of any criminal offense in the last 36 months?
Do you currently hold a license from any other Racing Commission to take part in races?
What is the state?
Has any of your license(s) to participate in racing ever been revoked or suspended for more than 10 days?
Are you presently employed by a Racing Association or Trainer?
I am applying for a license to be granted by the Horse Racing Board, as outlined in its Rules and Regulations. I confirm, under the risk of legal punishment for lying, that all the information and responses provided in my application are accurate and truthful.
Date
MonthDayYear
Date
Signature
Clear
Should be Empty: