Home Registration closes 16 October at 5pm First Name *Surname *Email Address *Date of Birth *Club *Cell *Work TelHome TelAre you a Club Member *YesNoClass choices are only shown after selected.Address *MechanicIf not completed and agreed, then no mechanic will be allowed in the mechanic zoneMechanic NameMechanic IDMechanic Consent Yes, I agree with the mechanics consent *Yes, agreedNo Mechanic assistanceMechanic Consent – Border MotocrossBike/raceBike Num *MSA #Class 1 Member *Class 1 MemberPL 50cc Class50cc NOVICE50cc ProPL 65cc Class65cc NOVICE65cc ProMX LITES125ccMX SeniorMX SupportMX ELITEEnduroClass 2 Member *Class 2 MemberNA65 ProMX Lites125ccMX SeniorMX SupportMX EliteEnduroClass 1 Non Member *Class 1 Non MemberPL 50cc Class50cc NOVICE50cc ProPL 65cc Class65cc NOVICE65cc ProMX LITES125ccMX SeniorMX SupportMX ELITEEnduroClass 2 Non Member *Class 2 Non MemberNA65 ProMX Lites125ccMX SeniorMX SupportMX EliteEnduroBike Make *Bike MakeHondaHusqvarnaKawasakiKTMSuzukiYamahaOtherOther Bike Make *Sibling Entry Discount *First entry, no discountSibling 2nd onwardsOnly check this box for sibling entries 2 and upSponsorSponsorHome TelCellWork TelEmail AddressLicence NumberConsent *Every entrant and driver / rider shall sign the relevant declaration and undertakings set out hereunder, which shall form part of the licence application form. 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 MSA following declaration of the disability. I further understand that, notwithstanding the issue of a licence to me by MSA it remains my responsibility not to participate in any event where a condition or disability suffered by me, may in any way affect my or other person’s safety. I declare that, to the best of my belief, 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 raceworthy / roadworthy, having regard to the speeds which will be reached. 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 / rider, in accordance with the provisions of MSA's regulations, if my vehicle / machine is found not to comply with the relevant regulations and specifications.Total DueRRegister
