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2018 NEW ZEALAND VETERAN & WOMENS MOTOCROSS
CHAMPIONSHIP ONLINE ENTRY FORM
1st & 2nd September 2018
PERMIT # 17429
for important information relating to this event
Please submit a seperate entry for each competitor.
Once you have completed all compulsory fields, read & accepted the Disclaimer select 'SUBMIT' at bottom of page.
Indicates required field
Class entered (Select class from dropdown list)
Vets 30-34yrs (any cc)
Vets 35-39yrs (any cc)
Vets 40-44yrs (any cc)
Vets 45-49yrs (any cc)
Vets 50-54yrs (All in)
Vets 55-59yrs (All in)
Vets 60-69yrs (All in)
Vets 70-79yrs (All in)
Vets 80years & Over (All in)
Senior Support (Non Championship Class) All in
Junior Ladies 8-12 yrs 85cc (60-85cc 2 st + 100-150cc 4st)
Junior Ladies 13-16 yrs 85cc (60-85cc 2 st + 100-150cc 4 st)
Junior Ladies 12-16yrs 125/250cc (90-125cc 2st + 151-250cc 4st (Min 14yrs 250cc 4 st)
Veteran Woman 30-39yrs
Veteran Woman 40yrs & over
Bike Make/CC (Select from dropdown list)
OTHER (Please complete in box below)
Bike Make/CC (Not if not in drop down selection)
Date of birth
Age on race day
MNZ Licence Number #
You must hold a current MNZ Club or Championship Licence to Compete in this Event. No One Event licences are being offered for this event
Payable by Direct Credit to SCMCC 03-0887-0240725-00
or Cheques to be made out to South Canterbury Motorcycle Club
Championship Class Entry - $120.00
Support Class Entry - $100.00
Late Entry fee - $25.00 (entries & payments received from 18th August)
Providing Own Mylaps MX Transponder (put pin# below) - Deduct $10
Own transponder pin #
Late Entry - Effective from 18th August
Intended Payment Method
Cheque Being Sent
Total Payment $
to see the terms and conditions (Supplementary Regulations)
Any questions regarding this event, please refer to supplementary regs for
contact details of club officials & event organisers.
I confirm information I have supplied is correct
I have read and accept the Disclaimer of Liability (below) for this event.
IF RIDER IS UNDER 16 YEARS OF AGE ON RACE DAY/(S). Name of Parent/Legal Guardian (who will be present on race day/s)
Direct Credit – SCMCC
03 - 0887 - 0240725 - 00
(Please include name in Particulars, '12000' in code & ' NZVet' as reference
Cheques payable to – South Canterbury Motorcycle Club, and post to
NZ Vet & Women's MX Champs
C/- Adele May
38 Davisons Road
DISCLAIMER OF LIABILITY:
To South Canterbury 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
NZ Veteran & Women’s Motocross Championship
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
South Canterbury 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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