MotoX Race Entry Form

SPEEDSPOT CLUB CHAMPIONSHIP ROUND 1

25 January 2020
(On-Line Entries close at 19:00 on 23 January 2020)

MSA Permit: MSA16209
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
NoneDean Hoffman PW50 Development Class (R350)50cc Newbies (R450)MX 50cc Pro (R550)MX 65cc (R550)MX 85cc (R550)MX Highschool (R650)MX Senior Support (R550)MX Funduro (R450)MX Quads Intermediate (R500)MX Quads Pro (R500)MX3 – Over 35 125cc (R550)MX3 – Vets (R550)MX3 – Masters (R550)MX Junior Support (R550)MX Pro (R650)

Non-Members 1st Class Entry
NoneDean Hoffman PW50 Development Class (R450)50cc Newbies (R500)MX 50cc Pro (R650)MX 65cc (R650)MX 85cc (R650)MX Highschool (R750)MX Senior Support (R650)MX Funduro (R500)MX Quads Intermediate (R500)MX Quads Pro (R500)MX3 – Over 35 125cc (R650)MX3 – Vets (R650)MX3 – Masters (R650)MX Junior Support (R650)MX Pro (R750)

Members 2nd Class Entry
NoneDean Hoffman PW50 Development Class (R350)50cc Newbies (R450)MX 50cc Pro (R450)MX 65cc (R450)MX 85cc (R450)MX Highschool (R450)MX Senior Support (R450)MX Funduro (R450)MX Quads Intermediate (R450)MX Quads Pro (R450)MX3 – Over 35 125cc (R450)MX3 – Vets (R450)MX3 – Masters (R450)MX Junior Support (R450)MX Pro (R450)

Non-Members 2nd Class Entry
NoneDean Hoffman PW50 Development Class (R350)50cc Newbies (R500)MX 50cc Pro (R500)MX 65cc (R500)MX 85cc (R500)MX Highschool (R500)MX Senior Support (R500)MX Funduro (R500)MX Quads Intermediate (R500)MX Quads Pro (R500)MX3 – Over 35 125cc (R500)MX3 – Vets (R500)MX3 – Masters (R500)MX Junior Support (R500)MX Pro (R500)

Members / Non-Members 2nd or 3rd family entry
Discounted fee.
Please use this field when you enter the second or third family entry only.
NoneDean Hoffman PW50 Development Class (R350)50cc Newbies (R450)MX 50cc Pro (R450)MX 65cc (R450)MX 85cc (R450)MX Highschool (R450)MX Senior Support (R450)MX Funduro (R450)MX Quads Intermediate (R450)MX Quads Pro (R450)MX3 – Over 35 125cc (R450)MX3 – Vets (R450)MX3 – Masters (R450)MX Junior Support (R450)MX Pro (R450)


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

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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