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CHRISTCHURCH OFF-ROAD MOTORCYCLE CLUB
SOUTH ISLAND MINI MX ONLINE ENTRY FORM
29th & 30th April 2017
Venue - West Melton Club Track
Entries close Friday 21st April at 5pm
Entries for Saturday only will be accepted - Entry fee $65 for one day - No late entry fee being charged
for full event information.
Complete all Compulsory fields then click on 'SUBMIT' at bottom of page
Please submit a seperate entry for each competitor
Competitors can compete on a MNZ Club or Championship Licence or a One Event Licence (supplied free of charge by MNZ for this event)
Please select your class from the drop down list
Unsure what class to enter - please contact Johnny Pirika 021 925881
NOTE: The Mini Intro Trail 4-5 & 6-8 years 50cc Trail class have been withdrawn as no entries received by closing date.
Entries still accepted for all other classes.
Indicates required field
Mini 4-7yrs Intro MX 50cc (no big SX's)
Mini 6-8yrs 50cc MX (air or liquid cooled, auto clutch max capacitiy 53cc)
Mini 7-8yrss 65cc MX
Mini 9-11yrs 65cc MX
Mini Trail 7-11yrs (2 st air cooled 53-82cc & 4 st air cooled 53-125cc)
Jnr 8-11 yrs MX (60-85cc 2 st + 100-150cc 4 st) Min 9yrs 150cc
Jnr 12-16yrs MX (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 One Event Licence Required)
ENTRY FEE (First family member, All classes) - $125.00
ENTRY FEE (ADDITIONAL FAMILY MEMBERS) - $80.00 PER RIDER
ONE EVENT LICENCE (COVERS BOTH DAYS) - NO CHARGE
SUPPLYING OWN MYLAPS MX TRANSPONDER - Deduct $10.00
LATE FEE - Not being charged, No day entries
SATURDAY ONLY - $65.00 ENTRY FEE
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
SI MINI MX FESTIVAL
C/- Adele May
38 Davisons Road
Direct Credit – CORMCC
03 - 0802 - 0877736 - 02
(Please include 'SI MINI' & 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
South Island Mini
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 approve helmet, along with approved boots, gloves, and motocross clothing as per the MNZ Manual of Motorcycle Sport – see www.mnz.co.nz
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 * 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
PH:(03) 686 4901 | 027 4576430
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