Gender *
MaleFemale
Age on Race Day *

First Name *

Last Name *

Email Address *

Cellphone Number *

Date of Birth (dd-MMM-yyyy) *

MEDICAL & EMERGENCY
Name of Emergency Contact *

Emergency Contact Number *

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

Racing Number *

Sponsors

Team Name

Members / non members
—50 cc Newbie R150MX 50 CC Development R150MX 50CC PRO R15065 and 85

TOTAL TO PAY: Calculate the total amount you owe *

If any question or comments, please type here

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. *
Yes

I have read and understand 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
Yes

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

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