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2017 ENDURO X & NUTBUSTER ONLINE ENTRY FORM
THIS FORM IS TO SUPPLY NECESSARY INFORMATION FOR ORGANISERS
Please ensure you read the Supplementary Regulations for these events
as they contain important information for competitors.
One Event Licence Application included within Entry form if required
Separate form to be competed for each competitor
Note: This year you can enter each event individually but maximum of 100 entries for Enduro X
& points are combined for both events for overall results.
Indicates required field
ENDURO X (Friday 17 November) - Select Class
SORRY ENTRIES FOR ENDURO X ARE CLOSED
Same bike/class applicable for both events.
NUTBUSTER (Saturday 18 November) - Select Class
NUTBUSTER ENTRIES OPEN - SELECT CLASS FROM DROPDOWN LIST
Ensure you refer to Supplementary Regulations for full information on classes so that you enter a class suitable to your ability
Machine & Capacity
Date of birth
Age on race day
MNZ Licence # (or OE if purchasing One Event Licence)
Ensure you read
section on Licencing
If under 18 years then One Event Licences must be countersigned by a Parent/Guardian.
Tee Shirt Size (select from drop down list)
SORRY TEE SHIRTS NO LONGER AVAILABLE
Tee Shirt included with Nutbuster entries received & paid prior closing (31st October)
Ensure deposited into Club account by 28th October 03-0802-0877736-02
Enduro X (incl entry to the A & P Show - no Tshirt) $100.00
Enduro X & Nutbuster (incl entry to A & P Show & Tshirt) - $150.00
Nutbuster Event only (incl TShirt) - $100.00
One Event Licence (covers both events) @ $30.00 each
Intended Payment Method
Cheque Being Sent
Total Payment $
Riders Bio (only required for Enduro X to assist commentator)
If rider is under 16 years of age on race day/s, or if under 18 years & require a One Event Licence.
Parent/Legal Guardian Name (who will be present on race day/s)
to see the terms and conditions (Supplementary Regulations)
I have read and accepted Disclaimer below & the Supplementary Regulations for this event and I enter at my own risk
I confirm information I have supplied is correct
LICENCE (Please select option from below)
I require a One Event Licence - I have read conditions below relating to a One Event Licence and agree to adhere to all conditions to compete at this event using the One Event Licence
I hold a MNZ Club or Championship Licence
Cheques payable to – Christchurch Off-road Motorcycle Club, and post to
C/- Adele May
38 Davisons Road
Direct Credit – CORMCC
03 - 0802 - 0877736 - 02
(Please include 'Nut', name, & class as a reference )
DISCLAIMER OF LIABILITY
: To Christchurch Off-Road 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 www.timingtech.co.nz
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
Enduro X &/or Nutbuster
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.
ONE EVENT LICENCE – I do not have a MNZ Competition Licence therefore require a One Event Licence for this event:
In the absence of holding a MNZ Competition Licence, I acknowledge that I am able to compete by partaking on a One Event Licence. By reading and acknowledging this disclaimer, the Supplementary Regulations and the following rules I acknowledge that I adhere to all conditions to compete at this event using the One Event Licence.
The ability to compete whilst using a one event licence may be withdrawn at any time by Motorcycling New Zealand.
I acknowledge that I will wear an approved helmet, along with approved boots, gloves, and motocross clothing as per the MNZ Manual of Motorcycle Sport – see
I acknowledge that no drugs or alcohol are permitted at this event, and I am not under the influence of either.
I acknowledge that I may be subject to random drug & alcohol testing as per the MNZ Manual of Motorcycle Sport.
I acknowledge that I have no medical condition that prevents me from safely participating in this event. I have not suffered concussion, or a head injury in the last three weeks.
My motorcycle is in a safe operating condition and type suited to the events that I am partaking in.
I acknowledge that attending riders briefing is compulsory
It is a condition of entry that all person having any connection with promotion, organisation, and conduct of the event including land owners, will be absolved from any liability out of any accident however caused and resulting in damage to property and or in respect of death or personal injury.
I fully indemnify Motorcycling New Zealand Inc., its agents representatives, employees, contractors, other competitors and promoters from and against any liability, whether or not due to any act or omission of these parties which arises from my participation in the event including by way of example any accident, damage or injury.
I agree that I have no medical condition that prevents me from safely participating in this event. I have not suffered concussion or had a head injury in the last three weeks. I acknowledge that should I suffer a head injury or concussion three weeks prior to this event that I will not partake due the MNZ stand down period.
Please make sure that you have filled out all compulsory fields (with red asterisk * ) & Click on 'SUBMIT ENTRY'
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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