MNZ Permit: TBA

Competitors (Rider) Full Name: ...... MNZ Licence No.

Postal Address ......

Competitors Phone Number: (0 ) ...... Mobile ......

BIKE NO. MACHINECCCLASS (as below)

......

CLASSES: $ 55 pre-entry $90.00 entry on day

 Superbike /  Development Senior
 Supersport /  Development Junior
 Supalite /  250 Prod./Lightweight Prod.
 Pro Twin /  Buckets F4
 125GP / Supermotard
Classics / Clubmans
Training / Sidecars

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Riders 18 years and under $20.00

Entry Fee pre-paid only$ 55.00

Entry Fee on the day entry$ 90.00

Day Licence$ 30.00

Transponder Hire $ 25.00

Own Transponder number

Total $......

On line payment: Westpac Armagh Street 03 0855 0359377 00 (please include name; race meeting)

Cheques payable to: Motorcycling Canterbury Inc.

Entry form to: Race Secretary Motorcycling Canterbury PO Box 4184 Christchurch

Pre-Entries CLOSE:Wednesday 6th September 2017 Fax: 03 359 8676Ph Dennis 022 187 0809
or EMAIL:

Pre-Entry fee will be refunded or transferred to next meeting if you cannot attend this meeting

This form must be signed over page!!! NO PAYMENT WITH ENTRY = LATE FEE APPLICABLE

READ THE FOLLOWING DECLARATIONS AND SIGN AT THE BOTTOM OF THE PAGE:

I have read and understood the Supplementary Regulations for this competition and agree to be bound by them and the Manual of Motorcycle Sport of Motorcycling New Zealand Inc. together with the terms of the Indemnification as hereunder, and the requirements of the Noise Restrictions as listed. I indemnify Motorcycling Canterbury Inc, Levels Raceway Ltd., Motorcycling New Zealand Inc., Local Bodies and Landowner, their agents and all Officials against any claims arising from my attendance at this meeting.

I forego any confidentiality of my records of attendance at this event to Official Organisations involved and concerned with the operations and safety of the event. I further consent to the details contained on this form being used for the purpose of the promotion and benefit of the Race Meeting concerned.

I hereby declare that the details I have written on this entry form are complete and correct.

Motorcycling New Zealand Disclaimer of Liability

TO: Motorcycling Canterbury Inc. and Motorcycling NZ Inc.

1. I have read the Supplementary Regulations for the competition and agree to be bound by them and the General Rules of Motorcycling NZ Inc.

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 this race meeting despite the above risks.

4. Neither I, nor 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 New Zealand 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 reassembly for Technical Checks are at my cost.

11.I consent to the details contained in this form being held by Motorcycling Canterbury Inc for the

purpose of the promotion and benefit of the race meeting concerned, and Motorcycling in general. I

acknowledge my right to access and correction of this information. This 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 the New Zealand Sports

Drug Agency (NZSDA) 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 tests together with the result of that testing.

13. I agree to pay in full or replace the hired transponder unit in the event it is damaged within 14days of
written notice from the organising club.

14. Machine examination is required for all bikes

DATED: ______

Signature of Rider(s):______

Name(s) (Print):______

IF UNDER 16 YEARS OF AGE

Parent/Guardian’s Name:______Signature:______

Address: ______