2016 NEW ZEALAND VETERAN & WOMENS MOTOCROSS 
                             CHAMPIONSHIP ONLINE ENTRY FORM
                                                                                     29th & 30th October 2016
                                                    PERMIT # 16373

    Refer Supplementary Regulations for important information relating to this event
    ​Note: You must have completed in 3 previous MNZ Permitted Events to be eligible to compete in a Championship class.  Please refer supplementary regulations for more details. 
    Note: Licence Upgrade with entry no longer available as of 1pm 21st October
    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.

    CLASSES

    COMPETITOR DETAILS

    Date of birth
    Ensure you read supplementary regulations section on Licencing. 
    You must hold a MNZ Championship Licence to Compete in a Championship Class (upgrades now no longer available - finished 21st October at 1pm)
    If under 18 years then One Event Licences must be countersigned on the day by a Parent/Guardian.
    You may compete in the Support Class on a One Event Licence or MNZ Club Licence.

    ENTRY FEES
    Payable by Direct Credit to MDMCC 03-0905-0904055-25
    or Cheques to be made out to Mosgiel Districts Motorcycle Club

    Championship Class Entry - $100.00
    2nd Class Entry - $40.00
    Support Class Entry - $80.00
    Special Event Licence Upgrade (refer sup regs) - $50.00 (no longer avaialable)
    One Event Licence (valid Support Class only) - $25.00
    Providing Own Mylaps MX Transponder (put pin# below) - Deduct $10
    CLICK HERE 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.

    PAYMENT DETAILS

    Direct Credit – MDMCC  03 - 0905 - 0904055 - 25
    (Please include name in Particulars, class in code & ' NZVet' as reference 
    Cheques payable to – Mosgiel & District Motorcycle Club, and post to

    NZ Vet & Women's MX Champs
    Timing Tech
    C/- Adele May
    38 Davisons Road
    NO2RD
    TIMARU 7972

       
    DISCLAIMER OF LIABILITY: To Mosgiel & Districts Motorcycle Club, and Motorcycling New Zealand Inc
    1. 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
    2. I am aware that the sport of Motorcycle Competition might a) cause me injury; serious or otherwise b) damage my property.
    3. I wish to take part in the NZ Veteran & Women’s Motocross Championship despite the above risks.
    4. 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.
    5. 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.
    6. I am physically fit and there is no health or other reason why I should not participate in the sport of Motorcycle Competition. 
    7. 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. 
    8. I agree that in this disclaimer “my property” includes any property owned by me or in my possession or under my control.
    9. I agree that this disclaimer will be binding on my family, my heirs, my legal assigns and my administrators and executors.
    10. I accept that stripping and re-assembly for Technical Checks are at my cost.
    11. I consent to the details contained in this form being held by the Mosgiel & District 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.
    12. 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.
    13. 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