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CHRISTCHURCH OFF-ROAD MOTORCYCLE CLUB
KING OF CANTERBURY ONLINE ENTRY FORM
10th & 11th September 2016
Venue - West Melton Club Track
Entries close Friday 3rd September at 5pm
for full event information.
Complete all Compulsory fields then click on 'SUBMIT' at bottom of page
Please submit a seperate entry for each competitor
Please select your class from the drop down list
Indicates required field
Mini 4-7yrs Intro 50cc Not Lapscored ( No big 50's)
Mini 4-6yrs 50cc MX (Little 50's)
Mini 6-8yrs Big 50cc (Big 50's)
Mini 7-8yrss 65cc MX
Mini 9-11yrs 65cc MX
Mini Trail 7-11yrs (53-82cc 2 stroke air-cooled or 53-125cc 4 stroke air-cooled)
Jnr Under 13yrs 85cc (60-85cc 2 st + 100-150cc 4 st) Min 9yrs 150cc
Jnr 13-16yrs 85cc (60-85cc 2 st + 100-150cc 4 st)
Bike Make & cc (Select from dropdown list)
OTHER (Add details in box below)
Machine & Capacity (if not in list above)
Date of birth
Age on race day
MNZ Licence # (or OE if purchasing One Event Licence)
ENTRY FEE (First family member, All classes except Intro) - $120.00
ENTRY FEE MINI INTRO (NOT LAPSCORED) - $80.00
ENTRY FEE (ADDITIONAL FAMILY MEMBERS) - $80.00 PER RIDER
ONE EVENT LICENCE (COVERS BOTH DAYS) - $25.00 PER RIDER
SUPPLYING OWN MYLAPS MX TRANSPONDER - Deduct $10.00
Transponder Pin# (If supplying own TX)
Intended Payment Method
Cheque Being Sent
Total Payment $
I confirm information I have supplied is correct
I have read and accept the Supplementary Regulations & Disclaimer for this event
Parent/Legal Guardian Name (To be present at the event)
to see the terms and conditions (Supplementary Regulations)
Any questions regarding this event, please refer to supplementary regs for
contact details of club officials.
Cheques payable to – Christchurch Off-Road Motorcycle Club, and post to
King of Canterbury
C/- Adele May
38 Davisons Road
Direct Credit – CORMCC
03 - 0802 - 0877736 - 02
(Please include 'KING', class & name as ref)
DISCLAIMER OF LIABILITY
: To Christchurch Offroad Motorcycle Club, and Motorcycling New Zealand Inc
I have read the Supplementary Regulations* for this Competition and agree to be bound by them and the Manual of Motorcycle Sport, the MNZ Constitution, and the MNZ Code of Conduct.
* Supplementary Regulations also available at
I am aware that the sport of Motorcycle Competition might a) cause me injury; serious or otherwise b) damage my property.
I wish to take part in the
King of Canterbury MX
despite the above risks.
Neither I, or anyone associated or connected with me will make any claim against you or your officers, employees or agents in respect of: a) any injury suffered by me; or b) any damage to any of my property regardless of how the injury or damage occurs.
I will indemnify you against all claims, damages or losses (including costs) which you incur as the direct or indirect result of any injury to me or damage to my property.
I am physically fit and there is no health or other reason why I should not participate in the sport of Motorcycle Competition.
I am aware that this disclaimer will not affect any legal obligations you have to me which you cannot contract out of under NZ Law.
I agree that in this disclaimer “my property” includes any property owned by me or in my possession or under my control.
I agree that this disclaimer will be binding on my family, my heirs, my legal assigns and my administrators and executors.
I accept that stripping and re-assembly for Technical Checks are at my cost.
I consent to the details contained in this form being held by the
Christchurch Off-Road Motorcycle Club
for the purpose of the promotion and the benefit of the race meeting concerned, and Motorcycling in general. I acknowledge my right to access and correction of this information. The consent is given in accordance with the Privacy Act 1993.
MNZ supports the FIM/IOC Charter on drugs in Sport. MNZ uses the services of Drug Free Sport NZ and other agencies to professionally carry out the testing. I acknowledge by signing this form I maybe subjected to a drug/alcohol test at any time. I agree to such testing. I further agree that my name can be published by MNZ as having taken part in a drug/alcohol test together with the results of that testing.
I confirm that my machine complies with any technical rule(s) set out in the Manual of Motorcycle Sport and/or the Supplementary Regulations and that, to the best of my knowledge and belief, it is in safe working order and fit for competition.
Please make sure that you have filled out all * required fields.
Your entry has been sucessfully submitted if this page converts to one thanking you for your entry.
(Allow approx 20 seconds to submit)
If you have missed a field "Please correct the highlighted fields" will appear below Submit Entry and the applic field will be outlined in Red
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