MotoX Entry Form:
23-Mar Pre-Nationals

    ZONE 7 SPEEDSPOT MX CLUB CHAMPIONSHIP - ROUND 2

    7 May 2022
    (Entries close at 20:00 on 4 May 2022)

    MSA Permit: MSA 16876
    Click Here to Download The Supplementary Regulations
    Info: Romanda Marais (Race secretary)
    Cellphone: 073 036-4468
    Email: mxadmin@zone7.co.za

    Chairman:
    Johann Spies
    Email: johann@zone7.co.za

    Fax number: 086 2733379


    NB NOTE
    This form is for a single rider only! Please submit a separate form for each family member rider! You can enter 2 classes with one form.

    Fields marked with (*) are compulsory. These fields must be completed for the form to be submitted correctly and successfully.

    RACING INFORMATION
    There will be NO ONE DAY event licences available at the event, please
    Contact Lizelle on 021 5561026 or email Lizelle@motorsport.co.za

    PERSONAL DETAILS

    Gender *
    MaleFemale
    Age on Race Day *

    First Name *

    Last Name *

    Email Address *

    Cellphone Number *

    RSA ID Number *

    Mechanics Name *

    Mechanics RSA ID Number *

    Mechanics Cellphone Number *

    MEDICAL & EMERGENCY

    Name of Emergency Contact *

    Emergency Contact Number *

    MSA LICENSE AND CLUB MEMBERSHIP

    Medical Cover
    YesNo
    MSA License Number

    Type of License
    ClubRegionalNational

    SpeedSpot MX Member *
    YesNo
    SpeedSpot MX Z Number
    eg: Z8888

    Racing Number *

    Sponsors

    Team Name

    CLASS SELECTION
    PLEASE READ CAREFULLY

    If you enter more than one class, for your second entry use the Members / non members 2nd class entry drop down where the cost of entry is already discounted in the form.

    Note:
    If a 2nd or 3rd family member is entered, choose the discounted fee or members / non members 2nd or 3rd family member entry class on the next form.

    Enter Class and secondary Class if necessary

    Members 1st Class Entry
    NoneMX 50cc Support (R450)MX 50cc (R550)MX 65cc (R550)MX 85cc (R550)MX Pro (R650)MX High School (R650)MX Support (R550)MX Quad (R500)Funduro (R350)

    Non-Members 1st Class Entry
    NoneMX 50cc Support (R500)MX 50cc (R650)MX 65cc (R650)MX 85cc (R650)MX Pro (R750)MX High School (R750)MX Support (R650)MX Quad (R550)Funduro (R450)

    Members 2nd Class Entry
    NoneMX 50cc Support (R450)MX 50cc (R450)MX 65cc (R450)MX 85cc (R450)MX Pro (R450)MX High School (R450)MX Support (R450)MX Quad (R450)Funduro (R450)

    Non-Members 2nd Class Entry
    NoneMX 50cc Support (R500)MX 50cc (R500)MX 65cc (R500)MX 85cc (R500)MX Pro (R500)MX High School (R500)MX Support (R500)MX Quad (R500)Funduro (R500)


    TOTAL TO PAY: Calculate the total amount you owe *

    If any question or comments, please type here

    YOUR SCRUTINEERING FORM


    PLEASE READ CAREFULLY

    I hereby declare that I will ride with all the above compulsory equipment as presented.
    Side Stands Not Permitted!

    TECHNICAL CONTROL AFTER ACCIDENT
    If a motorcycle is involved in an accident, the Technical Steward must check the machine to ensure that no defect of a serious nature has occurred. However, it is the responsibility of the rider / mechanic to present the machine for the re-examination together with helmet & clothing.

    I hereby accept the Declaration above. *

    Declaration/Undertaking to be signed by every competitor – Section 3

    I have read and understand GCR’s 93,94,99,121 and 122 of the MSA General Competition Rules 2019 and signify my/our agreement to abide by these
    rules by submitting this entry form. I, the lawful parent/guardian of the above-mentioned competitor, do hereby grant permission for him/her to ride in the
    above-mentioned event. If a competitor is a minor, this form must be submitted by the appropriate parent or guardian.

    Declaration/Undertaking by the competitor *
    If 18 years old or by the parent/guardian


    EFT PAYMENT

    Zone 7 Speedspot MSA
    Capitec Bank
    Branch Code: 47 00 10
    Acc #: 1368246638
    Reference: Name and Surname

    Please email relevant documents to mxadmin@zone7.co.za.

    NB NOTE
    This form is for a single rider only! Please submit a separate form for each family member rider! You can enter 2 classes with one form.

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