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Online Pre-Entry Form


2014 WOMZA Gauteng Motocross Championship - Round 5

Round 5: Saturday 2 August 2014

Permit No.: 4048

Pre-Entry Fee's:

Class:

Price:

Transponder included:

First

R630.00

Yes x 1

Second

R350.00

No *

Family Member

R430.00

Yes x 1

MX4 (Ladies)

R430.00

Yes x 1

50cc Junior

R430.00

Yes x 1

Open Support

R430.00

Yes x 1

* Additional Transponder Price: R80.00
(Available for Second class entries only.)

Venue: Dirt Bronco
Address: Viscount Road, Luipaardsvlei
Krugersdorp, Gauteng
GPS: 26° 7'0.86"S - 27°45'54.69"E
Race Rules & Regulations: Download Here

Early Bird Race Registration: Friday 1 August at Raceworx KTM, Clearwater Mall. 16:00 - 18:00pm

Race Day Registration: 06:00 - 07:00am at Dirt Bronco on 2 August.

 

Pre-Payments Closing Date: Thursday 31st July
NO cash will be accepted on race day. Please ensure EFT by 31st July!

Please ensure you pay the correct fees! If you are unsure please contact MX SA to confirm your fee's. Incorrect fees will not be refunded.

If you have made payment and for some reason cannot attend at the last minute, arrangements can be made with Noleen and we will carry your payment over as credit for the next race.

PLEASE NOTE: A PRE ENTRY IS ONLY CONSIDERED COMPLETED AND ACCEPTED ONCE PAYMENT HAS BEEN MADE AND SCRUTINEERING SUBMITTED.

Personal Information

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

Surname*:

 

Full Name*:

Date of Birth:

 

Address:

Tel No.: (H)

 

Tel No.: (W)

 

Cell No.*:

 

Fax No.:

 

E Mail*:

 

Medical Cover


Medical Cover:

WOMZA
Private

 

Medical Aid No.:

Name of Medical:

 

 

 

 

Racing Information


Licence No.*:

 

Bike No.*:

Club*:

 

Bike Make:

Membership No.:

 

Bike Model/s:

Sponsors:

 

 

 

 

Classes


Tick the boxes to choose your relevant class. Tick multiple for more then one class.

- 50cc Junior

 

- MX1

 

- MX3 Vets

- 50cc Senior

 

- MX2

 

- MX3 Masters

- 65cc

 

- MX2B

 

- MX4 (Women's MX)

- 85cc

 

- 125cc

 

- Open Support

- Pro Mini

 

 

 

 

 

 

 

Declaration/Undertaking by the competitor
Every entrant and rider shall accept the relevant declaration and undertakings set out hereunder, which shall form part of the License application form:

By submitting this form you agree to the following:

i)

I understand that should I at the time of an event in which I intend taking part, be suffering from any condition/disability (whether permanent or temporary) which is likely to prejudicially affect my control of my vehicle/machine, I may not take part in the event concerned unless expressly permitted to do so by WOMZA following declaration/disability. I further understand that, notwithstanding the issue of a Licence to me by WOMZA it remains my responsibility not to participate in any event where a condition or disability suffered by me, may in anyway affect my or other person’s safety.

ii)

I declare that, to the best of my belief, or the driver(s)/ rider(s) entered by me possess the standard of competence necessary to take part in any event entered, and that any vehicle/machine entered will be suitable and race-worthy, having regard to the high Speeds which will be reached.

iii)

I declare that any vehicle/machine entered by me, will comply with all regulations and specifications pertaining to the event entered/category of motorsport concerned. I accept, subject to my rights of protest and appeal that action will be taken against me, as the entrant driver or rider, in accordance with the provisions of WOMZA regulations, if my vehicle/machine is found not to comply with the relevant regulations and specifications.

I hereby accept the Declaration above*.

I hereby confirm i have read the Rules and Regulations for this event*.


Race Rules & Regulations: Download Here

Enter security code:





Online Entry Enquiries: Michelle Smith
For more information please contact 082 413 8556 or info@mxsa.co.za

Please make payment and send the Proof of Payment to:
Fax : 086 530 6485 OR E-Mail : info@mxsa.co.za
Clearly marked with:
Rider Surname and Bike Number.

Bank Details:
Motocross SA Events
Bank : First National Bank (FNB)
Branch : Clearwater
Branch Code : 251141
Acc. No. : 623 926 856 27
Please deposit the payment and send the desposit slip to:
Fax : 086 532 9965 OR E-Mail : noleen@mxsa.co.za

 

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