motorcycling
canterbury
po box 4184 christchurch
www.motorcyclingcanterbury.org.nz
ADVANCED RIDER TRAINING DAY
Saturday 19th May 2012
Levels Raceway Timaru
Name:
………………………………………………………………………………………...
Address:
………………………………………………………………………………………...
Phone:
………………………
Age:………
Machine:………………………
Email: …………………………………………………………………………………………………
Please select the group you wish to ride in:
Group A
Group B
Group C
Group D
Group E
Experienced Road Riders No MNZ Licence Holders
Intermediate Road Riders
RG 150 Streetstock /Buckets/Novice Riders
RG 150 Streetstock training; RG 50 training; First time on track riders – coaching
MNZ Licence Riders only ( no racing ) Training and Testing Only
Entry Fee: $70 per rider (includes photograph)
16 years and under
$15 per rider
Please enclose entry fee with entry form
Please make cheques payable to Motorcycling Canterbury, P O Box 4184, Christchurch
Or email to craig.wendy@clear.net.nz; fax 03 359 8676 Direct payment to Westpac Armagh 03 0855 0359377 00
Track Opens at 7.15 am, Sign in open from 7.30am.
Disclaimer of Liability:
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I have read any supplementary regulations for this meeting and agree to be bound by them and the MNZ general rules
I am aware that the sport of motorcycling might cause injury serious or otherwise or, damage to my property
I wish to take part in the track day despite the above
Neither I nor anyone associated with me will make any claim against you or your officers or agents in respect of any
injury suffered by me or damage to my property regardless of how the injury or damage happened
I will indemnify you against all claims, damages or losses (including costs) which you incur as a direct or indirect
result of any injury to me or damage to my property
I am physically fit and there are no health or other reasons why I should not participate in the track day
I am aware that this disclaimer will not affect any legal obligation you have to me which you cannot contract out of
under NZ law
I agree that in this disclaimer “my property” includes any property owned by me or in my possession or under my
control
I agree that this disclaimer will be binding on my family, my heirs, my legal assigns and my legal administrators and
executors
I consent to the details obtained in this form being held by Motorcycling Canterbury for the purpose of the promotion
and the benefit of the track day and motorcycling in general. I acknowledge my right to access and correct this
information. The consent is given in accordance with the Privacy Act 1993.
MNZ supports the FIM/charter on drugs in sport. MNZ uses the services of the NZ Drug Sports Agency to
professionally carry out the testing. I acknowledge by signing this form I may be subject to a drug/alcohol test at any
time. I agree to such testing. I further agree that my name can be published by MNZ as having taken part in a
drug/alcohol test together with the results of that testing.
Signed:……………………………………………………………………Date:…………………………………….