Saturday: Mini GP, Junior GP, Senior Support
Sunday: Senior GP, Senior Womens GP, Veterans GP, River Race
Name:
Phone:
Address:
Email: Please print clearly
Age:
Date of birth:
Racing no:
MNZ Licence No:
Bike Make / Model:
Mob:
Class: (as in MNZ Licence)
Club:
PERSONAL TRANSPONDER NO: *Must supply transponder no:
Sponsors
Grand Prix Championship classes in bold
Mini Track – Sat 30th January
$
Intro 1: 4-5 yrs 50cc Trail
55
Intro 2: 6-8 yrs 50cc Trail
55
√
Please √ the box of the class you wish to enter
Intro MX: 4-7 yrs 50cc Intro
55
Main Track – Sat 30th January
8 -10 yrs 60-85cc 2 stroke & 100-150cc
4 stroke (min age for 150 4 stroke is 9 years)
11 -12 yrs 60-85cc 2 stroke & 100-150cc
4 stroke
13 -16 yrs 60-85cc 2 stroke & 100-150
4 stroke
$
√
Main Track – Sun 31st January
$
100
Grand Prix 125cc
110
MX 6-8 yrs 50cc
65
12 -14 yrs 90-125cc 2 stroke
100
Grand Prix Veterans 40 yrs plus
110
Trail 7-11 yrs
65
15-16 yrs 90-125cc 2 stroke
100
100
MX 7-8 yrs 65cc
65
14-16 years 151cc-250cc 4 stroke
100
Grand Prix Senior Womens
River Race
If riding as a second class - $20
MX 9-11 yrs 65cc
65
Senior Support Under
$80
Senior Support Overs
$80
100
Grand Prix MX 1
110
100
Grand Prix MX 2
110
Special Event Upgrade Licence: For all riders who are competing in the Championship classes who hold a Club Licence; you can
purchase a special event upgrade licence, this licence must be applied and paid for with this entry form by entry closing date. You must
have competed in; Senior – 3 previous MNZ permitted events; Junior – 6 previous MNZ permitted events proof of which will be from your
log book. A rider can only purchase 1 Special Event Upgrade Licence in a licencing season
√
$40
$50
ENTRY FEE *IF SUPPLYING OWN TRANSPONDER – DEDUCT $5 FROM ENTRY FEE
nd
ENTRIES CLOSE: 5pm, Friday 22 January 2016 - (Late fee will be enforced) $50 LATE ENTRY FEE
Enter Online - www.mxt.co.nz
Paid by Direct Credit / Cheque (please circle one)
Total Payment
DISCLAIMER OF LIABILITY: To-Manawatu-Orion 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 General Rules of MNZ 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 the MNZ International Grand Prix competition 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 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 Manawatu-Orion 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 the Drug Free Sport NZ (DFSNZ) 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.
Date: ……..…./…..……./2016 Signature of Rider: …............……………………………………………………...……………………………..
Parent/Legal Guardian: .................................................……………………............... Relationship:.…………..................................………
(who is to be present on race day if rider is under 16 years of age).
Make cheques payable to: Manawatu-Orion Motorcycle Club
PAYMENT INFO: By Internet banking & accepted only if paid with reference of rider surname & class i.e. Smith 13-16 85cc. Payment must be
received before entry will be processed. National Bank – Palmerston North - 06 0746 0075594 00 Manawatu-Orion Motorcycle Club
Enter online at www.mxt.co.nz or post entry to MOMCC, C/- MX Timing Ltd, PO Box 562, Taupo
Entries Close 5.00 pm, Friday 22nd January 2016
See www.momcc.co.nz or www.facebook.manawatu orion for Event updates, Sponsors, Camping
& Accommodation Information.
Total Prize Package PRIZE MONEY & TROPHIES $22,000.00 +
ALL COMPETITORS WILL BE ACKNOWLEDGED
TROPHIES 1st/2nd/ 3rd & MEDALS: for all Minis
JUNIOR GRAND PRIX CLASSES, GRAND PRIX WOMENS, GRAND PRIX VETERANS:
Trophies 1st/2nd/3rd, Prize money to 5th place, Medals 4th onwards.
SENIOR SUPPORT: Trophies 1st/2nd/3rd, Medals 4th onwards
PRIZEMONEY SCALE: for all Grand Prix Seniors, plus River Races & International Classes.
1st $400.00 2nd $350.00 3rd $300.00 4th $250.00 5th $200.00
Roddy Shirriffs Memorial $300
Should entry numbers dictate, qualifying for Saturday’s racing will be held on Friday 29th January
RACING DATES:
Friday 29th January:
Saturday 30th January:
Sunday 31st January:
CLOSING DATE:
ACCEPTANCES:
CONDITIONS OF ENTRY:
ENTRY NUMBERS:
NO DOGS:
NO TEAR OFFS:
TRANSPONDERS:
ONLINE ENTRY:
ENTRY FORMS:
PAYMENT INFO:
PROTEST COMMITTEE:
LATE ENTRY FEE:
REFUNDS:
FORCE MAJEURE:
Early bird sign in for Junior GP & Senior Support Classes - Main Track 3.00-5.00pm
Main Track: Sign In 6.00 – 7am - Briefing at 7.15am - Racing for Junior GP, Senior Support
Mini Track: Sign In 7am – 8am - Briefing at 7.15am - Qualifying (if required) & Racing for Minis
Sign In Main track 6am – 7am - Briefing at 7.15am - Qualifying (if required) and Racing for Senior GP, Womens GP,
Veterans GP, Invitation International & River Races
Entries close 5.00 pm, Friday 22nd January 2016
No Acceptances/tickets will be mailed. Online entries will be confirmed by email. See www.momcc.co.nz or www.mxt.co.nz
for rider lists and updates. Gates will be closed when your Riders Briefing commences and all entering venue after that time
will be charged gate admission. Saturday riders will receive 1 x free gate pass for Sunday following Saturday’s race
programme.
1. TO BE ELIGIBLE TO RACE AS A MINI OR JUNIOR AT A MNZ CHAMPIONSHIP EVENT RIDERS MUST HAVE AT
LEAST 6 MNZ SANCTIONED EVENTS IN LOG BOOK, however this ruling does not apply to Mini Support Classes.
2. CHAMPIONSHIP LICENCES COMPULSORY for all Championship classes alternatively, Special Event Upgrade
available see entry form.
3. MNZ Club Licence or day licence valid for all Support classes
Senior Support Classes – restricted to first 40 entries received per class
Dogs are not permitted at this venue and will be asked to leave
Please note tear offs are not permitted at this venue (incl. biodegradable)
$5.00 may be deducted from Entry Fee if you are supplying your own however this TX NUMBER MUST BE SUPPLIED ON
ENTRY FORM AT TIME OF ENTRY TO BE ELIGIBLE FOR DISCOUNT
www.mxt.co.nz / print version for download www.momcc.co.nz
Entry Forms must be filled in correctly. Incorrectly completed entry forms will not be accepted and returned to sender.
Entry details, including Race Numbers cannot altered on Race Day.
By Internet banking & accepted only if paid with reference of rider surname & class i.e. Smith 13-16 85cc. Payment must be
received before entry will be processed. 06 0746 0075594 00 Manawatu-Orion Motorcycle Club - National Bank Palmerston North.
MNZ Steward, Clerk of the Course, and Rider Representative
Entry Fee plus $50.00, and only if places available.
Please note the MNZ Rule 5-5-2 will be applied.
For reasons for Force Majeure, should a meeting or part of a meeting be cancelled, any entry fee refunds will be made at
the sole discretion of the organisers. The organisers reserve the right to alter the meeting format as deemed necessary
OFFICIALS:
MNZ Steward: John Tootell
Clerk of the Course: Dave Craig
Riders Representatives: To be appointed at Riders Briefing
Event Secretary: Anna Cvitanovich 063286869 Email: [email protected]
Mini Coordinator: James Smith 0273 323742
Entry queries: Nicole Bol, MX Timing Ltd – 027 2011177
MNZ Permit: 15988
Enter online at www.mxt.co.nz or post entry to MOMCC, C/- MX Timing Ltd, PO Box 562, Taupo
Entries Close 5.00 pm, Friday 22nd January 2016