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PRE EVENT INFORMATION
CANTERBURY 6 HOUR CROSS COUNTRY - ONLINE ENTRY FORM
for full event information.
Please submit a seperate entry for each competitor.
Ensure all sections are completed and click 'Submit' at very bottom page to lodge your entry
Please select your class from the drop down list
Indicates required field
Class entered (Select class)
3 HOUR SOLO
6 HOUR SOLO (Must be on a Senior Licence)
6 HOUR TEAM (2 Riders / 1 Bike)
6 HOUR TEAM (2 Riders / 2 Bikes)
6 HOUR VET TEAM (40 years & over) 2 Riders / 1 or 2 Bikes
Machine & Capacity
Date of birth
Age on race day
MNZ Licence # (Must hold Championship Licence)
Junior Class Entry Fee - $50.00
Senior Class Entry Fee - $70.00
Tracktion Entry also - $30.00 (must reside in Canterbury)
Intended Payment Method
Cheque Being Sent
Total Payment $
DISCLAIMER OF LIABILITY: To Christchurch Off-Road 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
Round 3 2017 South Island
Cross Country Series
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
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.
12. MNZ supports the FIM/IOC Charter on drugs in Sport. MNZ uses the services of Drug Free Sport NZ & 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.
If rider is under 16 years of age on race day, to be authorised by Parent/Guardian
Parent/Legal Guardian Name (who will be present on race day/s)
to see the terms and conditions (Supplementary Regulations)
Any questions regarding this event, please refer to supplementary regs for
contact details of club officials.
I have read and accepted Disclaimer above and I enter at my own risk
I confirm information I have supplied is correct
Cheques payable to – Christchurch Off-road Motorcycle Club, and post to
Tracktion SI Cross Country
C/- Adele May
38 Davisons Road
Direct Credit – CORMCC
03 - 0802 - 0877736 - 02
(Please include name in Particulars, class in code & 'SICC' as reference
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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