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Cross Country & Sprint
2012 CALENDAR

2012 TM Racing Forest 300 Race Entry Form

Rider Details

2012 Racing Number *
 This is a Registered MNSW Racing Number 
Riders Full Name *
Class *
See Supplementary Regs for Class descriptions
Date of Birth *

DD 		/
MM 		/
YYYY
MA Licence Number *
Please enter the Expiry date of your MA Licence
Expiry Date *

DD 		/
MM 		/
YYYY
Motorcycle Make *
Capacity: *
Stroke: *
 2 Stroke 
 4 Stroke 
Rego No:
Rider RTA Licence No:
Rider RTA Licence Expiry Date:

DD 		/
MM 		/
YYYY
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Email *
Contact Telephone Number (Mobile)
Entrant
(Your Sponsor)
Entrants MA Licence Number
(Required if Entrant completed above)
Expiry Date for Entrants MA Licence

DD 		/
MM 		/
YYYY
Please enter the Expiry date of the Entrant's MA Licence

My Transponder Number is
ENTRY FEE
Early Bird Entry closes 12 days before the event.
Standard Entries close 7 days before the event. *
 Early Bird Senior - $175 
 Early Bird Junior - $120 
 Standard Senior - $190 
 Standard Junior - $135 
 I have my own Transponder - Subtract $12 
 Camping (Family) - $30 
 Camping (Single) - $15 
BANK DETAILS: BSB: 032-529 A/C NO: 229549 ACCOUNT NAME: Dungog MCC

Your entry will NOT be accepted unless you include a copy of your bank deposit slip.
Email to TREEN.SARGENT@BIGPOND.COM

MAKE CHEQUES PAYABLE TO: Dungog Motorcycle Club
POST TO: 104 Buff Point Ave, Buff Point 2262

Contact:
Treena on 0438 721 024 (5PM - 8:30PM) or
Brad on 0428 921 746(5PM - 8:30PM)
NO CALLS AFTER 8.30PM
Upload your Deposit Slip Now

I ACKNOWLEDGE THAT THIS MEETING WILL BE HELD IN ACCORDANCE WITH THE CURRENT GENERAL COMPETITION RULES (GCR’S), THE SUPPLEMENTARY REGULATIONS (OF WHICH THIS ENTRY FORM FORMS PART), THE BY-LAWS OF MNSW AND ANY FINAL INSTRUCTIONS. *
 Yes, I agree. 
BY ENTERING THIS MEETING ALL PARTIES AGREE TO COMPLY WITH THESE RULES,
REGULATIONS, BY-LAWS AND INSTRUCTIONS.

Remarks

Please bring your original forms with you to signon
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Last modified: 12/04/12