2021 Northern Regional Motocross Championship - Round 4

    4 September 2021
    (On-Line Entries close at midnight on 1 September 2021, NO LATE ENTRIES)

    MSA Permit: MSA
    Click Here to Download The Supplementary Regulations
    Info: Vinessa Broskie or Noleen Roome (Race secretary)
    Cellphone:082 804 7072 or 082 850 1450
    Email: vinessa@cdosing.co.za
    Noleen Roome
    Email: noleen@mxsa.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.

    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 Carmen on 011 675 2220 or email carmen@motorsport.co.za

    PERSONAL DETAILS

    Gender *
    MaleFemale
    Date of Birth *

    First Name *

    Last Name *

    Email Address *

    Cellphone Number *

    Region *

    Residential Address *


    MEDICAL & EMERGENCY

    Name of Emergency Contact *

    Emergency Contact Number *

    MSA LICENSE
    MSA License Number *
    This is a Numeric field and will only allow you to enter your 5 digit MSA Number. If international Rider, please only enter the last 5 digits of your license number and ensure your start permission has been sent to the race organisers.

    Type of License *
    ClubRegionalNationalFIM
    Bike Number*
    Please ensure that your bike Number has been reserved and verified by Carmen at carmen@motorsport.co.za

    Sponsors

    Team Name

    Bike Manufacturer


    CLASS SELECTION
    PLEASE READ CAREFULLY

    If you enter more than one class, for your second entry use the 2nd class entry where the cost of entry is already discounted in the form. For each additional Family Member please enter a separate entry form and choose 2nd Family Member.

    Enter Class and secondary Class if necessary

    1st Class Entry
    NoneMX50cc (R850)MX65cc (R850)MX85cc (R850)Pro Mini (R850)MX Highschool (R850)MX3 (R850)MX1 (R850)MX2 (R850)MX Ladies (R850)Senior Support / Enduro (R550)

    2nd Class Entry
    NoneMX50cc (R400)MX65cc (R400)MX85cc (R400)Pro Mini (R400)MX Highschool (R400)MX3 (R400)MX1 (R400)MX2 (R400)MX Ladies (R400)

    2nd Family Member - 1st Class Entry
    NoneMX50cc (R650)MX65cc (R650)MX85cc (R650)Pro Mini (R650)MX Highschool (R650)MX3 (R650)MX1 (R650)MX2 (R650)MX Ladies (R650)Senior Support / Enduro (R550)

    2nd Family Member - 2nd Class Entry
    NoneMX50cc (R400)MX65cc (R400)MX85cc (R400)Pro Mini (R400)MX Highschool (R400)MX3 (R400)MX1 (R400)MX2 (R400)MX Ladies (R400)

    Number of Crew Members
    PLEASE READ CAREFULLY

    R60 entry fee for each crew member accompanying the rider with a maximum of 2 Additional members. Please indicate amount of crew members and ensure that you complete the Covid Attendance Register Form at the bottom of THIS entry for EACH of these members and add this to your Total To Pay.
    NB: Only Attendees on the Register will be allowed into the venue.

    [None1 Mechanic - Free1 x Additional Crew R 602 x Additional Crew R 120


    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!

    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 2021 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.


    COVID-19 Operations Plan

    Download Covid OPS Plan

    I have read and Understand the COVID operations plan for this event and signify my/our agreement to abide by these rules by submitting this entry form.

    Please note that a Maximum amount of attendees excluding the rider is 3, For each person other that the rider accompanying the rider, please complete the attached link as part of the COVID Attendance register. Only Registered attendees will be allowed into the venue.

    Follow the below link to complete the attendance register:

    COVID Attendance Register Form

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


    EFT PAYMENT

    Raceway Park

    Standard bank
    Branch code 016342
    Cheque account
    No 421656182
    Reference: Surname, Class & Bike Number

    Please email ONLY Proof of Payment to vinessa@cdosing.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.
    Please note that the form clears all field after successful submission, No need to re enter

    Warning – Motorsport is dangerous.
    In view of the high speeds attained by the competitors, accidents can happen. The promoters and organisers of this race meeting/event/competition cannot guarantee your safety. You are present at your own risk.
    Vrywaring – Motorsport is gevaarlik.
    Weens die hoë snelhede wat deur deelnemers bereik word, kan ongelukke gebeur. Die promoter's en organiseerders van hierdie byeenkoms kan derhalwe nie die veiligheid van toeskouers waarborg nie. U is teenwoordig op u eie risiko.
    Isilumkiso – Ukhuphiswano lwe-moto luyinggozi.
    Kangangohlobo lokuba abaqgatsi abaqhuba iimoto ngamendu aphakamileyo nengozi zingenzeka. Abaxhasi nabagqugquzeli bolu khuphiswano abanaso isiqinisekiso sokuphepha kuwo wonke umntu ongumbukeli wolu khupiswano. Ngokuba apha ubomi bakho busengozini.
    Isexwayiso – Ngobungozi bomjaho wezimoto.
    Maqondana nesivinini esiba emjahweni wezimoto ingozi ingenzeka kalula. Abagqugquzeli nabahleli balomjaho abanaso isiqinisekiso sokuphepha kwezi bukeli. Ukuphepha kwakho kusezandleni zakho.