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PRE EVENT INFORMATION
2020 SOUTH ISLAND CHAMPS / THUNDER-X MX ONLINE ENTRY FORM
Saturday 11th & Sunday 12th January 2020 - Permit #18770
Hosted by Gore & Districts Motorcycle Club
Please refer
Supplementary Regulations
for full event information
Please submit a seperate entry for each competitor
Complete all compulsory fields and then click on 'Submit Entry' at bottom of page
CLASSES
Classes will be finalised from prepaid entries received by closing date. If sufficient entries have not been received some classes may be combined or cancelled.
*
Indicates required field
Class entered (select from drop down list)
*
.
Mini Intro MX 4-6 yrs 50cc (air or liquid cooled, auto clutch)
Mini MX50 6-8 years (2 stroke, auto clutch, max capacity 53cc)
Mini MX65 7-11 years (2 stroke 53-65cc gear box and manual clutch)
Mini Trail 7-11 years (2 stroke air cooled 53-82cc & 4 stroke air cooled 53-149cc) * Exception max 110cc 4 st for 7 year olds
Junior 8-11yrs (up to 85cc 2st + up to 150cc 4st)
Junior 12-16yrs (up to 85cc 2st + up to 150cc 4st)
Junior 12-16yrs (90-125cc 2 stroke only)
Junior 14-16yrs (151-250cc 4 stroke & 126-150cc 2 stroke)
Senior MX1 (151cc-Open 2 st & 251cc-Open 4 st)
Senior MX2 (126-150cc 2 st & 250cc 4 st)
Senior Support Vets 40yrs + (open cc)
Senior MX125 (90-125cc 2 stroke)
Senior Support all in
Only Senior Licenced riders eligible for Senior Feature Trophies & Prizemoney.
COMPETITOR DETAILS
Race Number
*
Name
*
First
Last
Machine & Capacity
*
Email
*
Phone
*
Emergency Contact (Name & Phone number)
*
Date of birth
DD
*
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MM
*
01
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YYYY
*
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Age on race day
*
2nd Class Race Number
*
2nd Class entered
*
.
Mini MX65 7-11 years (2 stroke, 53-65cc gear box and manual clutch)
Mini Trail 7-11 years (2 stroke air cooled 53-82cc & 4 stroke air cooled 53-149cc) * Exception max 110cc 4 st for 7 year olds
Junior 8-11yrs (up to 85cc 2st + up to 150cc 4st)
Junior 12-16yrs (up to 85cc 2st + up to 150cc 4st)
Junior 12-16yrs (90-125cc 2 stroke only)
Junior 14-16yrs (151-250cc 4 stroke & 126-150cc 2 stroke)
Senior MX1 (151cc-Open 2 st & 251-Open 4 st)
Senior MX2 (126-150cc 2 st & 250cc 4 st)
Senior Support (all in)
Support Vets 40yrs + (open cc)
2nd Class Machine & Capacity
*
Address
*
Town/City
*
MNZ Licence # (or OE if require a One Event Licence)
*
Sponsors
*
FEES
Choose Applicable
*
Junior/Senior class entry fee - $120.00
Mini Class entry fee - $80.00
One Event Licence Required - $30.00
Own Mylaps Transponder (provide pin number) Deduct $10
Late Entry - Compulsory from 7th January 2020
*
Late Entry Fee - $30.00
Intended Payment Method
*
Direct Credit
Cheque Being Sent
Total Payment $
*
Parent/Legal Guardian Name (to be present at event)
*
If rider is under 16 years of age on race day or under 18 years & requires a One Event Licence
DISCLAIMER OF LIABILITY: To Gore & Districts 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
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
2020 South Island Motocross Championship/Thundercross
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
Gore & Districts 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.
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.
Click Here for EVENT INFORMATION
and to see the terms and conditions for this event (Supplementary Regulations)
Any questions regarding this event, please refer to supplementary regs for
contact details of club officials.
I have read and accepted Terms and Conditions & Disclaimer above and I enter at my own risk
*
Yes
I confirm information I have supplied is correct
*
Yes
PAYMENT DETAILS
Cheques payable to – Gore & Districts Motorcycle Club, and post to
South Island MX Champs/Thundercross
C/- Adele May
Timing Tech
38 Davisons Road
2RD
TIMARU 7972
Direct Credit – GDMCC
03 - 0915 - 0256944 - 00
(Please include class & name as ref)
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