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2018 NEW ZEALAND VETERAN & WOMENS MOTOCROSS
CHAMPIONSHIP ONLINE ENTRY FORM
1st & 2nd September 2018
PERMIT # 17429
Refer
Supplementary Regulations
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.
CLASSES
Note: As of close of entries 5pm 22nd August, Vet 80yrs+ & both Women's Veteran classes have been closed.
Entries in all other classes only accepted with the late fee and subject to organisers discretion (you will be advised if not accepted). No day entries will be accepted.
*
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 (CLASS CLOSED)
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)
Senior Woman
Veteran Woman 30-39yrs (CLASS CLOSED)
Veteran Woman 40yrs & over (CLASS CLOSED)
COMPETITOR DETAILS
Race Number
*
Name
*
First
Last
Bike Make/CC (Select from dropdown list)
*
.
Honda CR85
Honda CR110F
Honda CR125
Honda CR150R
Honda CRF150F
Honda CRF230F
Honda CR250R
Honda CRF250X
Honda CR250L
Honda CRF450R
Honda CRF450X
Honda XR650L
Husqvarna TC85
Husqvarna TC125
Husqvarna TX125
Husqvarna TC250
Husqvarna TE250
Husqvarna FC250
Husqvarna FE250
Husqvarna TX300
Husqvarna TE300
Husqvarna FC350
Husqvarna FX350
Husqvarna FE350
Husqvarna FE450
Husqvarna FC450
Husqvarna FX450
Husqvarna FE501
Kawasaki KX85
Kawasaki KLX110
Kawasaki KX125
Kawasaki KLX140
Kawasaki KDX200
Kawasaki KX250
Kawasaki KX250F
Kawasaki KX450F
KTM85SX
KTM125SX
KTM125XC-W
KTM150SX
KTM150XC-W
KTM250SX
KTM250SX-F
KTM250EXC
KTM250XC-F
KTM250XC
KTM300EXC
KTM300XC
KTM350SXF
KTM350EXC
KTM350XC-F
KTM450SX-F
KTM450EXC-F
KTM450XC-F
KTM500EXC-F
KTM500EXC
OTHER (Please complete in box below)
Suzuki RM85
Suzuki RM125
Suzuki DR-Z125
Suzuki DR200
Suzuki RM250
Suzuki RM-Z250
Suzuki DR-Z400
Suzuki RM-Z450
Suzuki DR650
Yamaha YZ85
Yamaha TT-R100
Yamaha YZ125
Yamaha TT-R125
Yamaha TT-R230
Yamaha YZ250
Yamaha YZ250F
Yamaha YZ250X
Yamaha YZ250FX
Yamaha WR250F
Yamaha YZ450F
Yamaha YZ450F
Yamaha WR450F
Bike Make/CC (Not if not in drop down selection)
*
Email
*
Phone
*
Date of birth
DD
*
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31
MM
*
01
02
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04
05
06
07
08
09
10
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YYYY
*
2013
2012
2011
2010
2009
2008
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1949
1948
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1944
1943
1942
1941
1940
Age on race day
*
Address
*
Town/City
*
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
ENTRY FEES
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 5pm 22nd August
*
$25.00
Intended Payment Method
*
Direct Credit
Cheque Being Sent
Total Payment $
*
Competitor Sponsors
*
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.
I confirm information I have supplied is correct
*
Yes
I have read and accept the Disclaimer of Liability (below) for this event.
*
Yes
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)
*
PAYMENT DETAILS
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
Timing Tech
C/- Adele May
38 Davisons Road
NO2RD
TIMARU 7972
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
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
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
Submit Entry