- Aust Jnr DT SOMERSBY

2019 HONDA

AUSTRALIAN JUNIOR DIRT TRACK CHAMPIONSHIPS

Entry Form

SATURDAY 28TH AND SUNDAY 29TH SEPTEMBER 2019

ALLEN PARK MVRG DEBENHAM ROAD NORTH SOMERSBY NSW

Please read Sup Regs click here before filling out this form.

Entry Fees.

Juniors $140 extra classes $30 each.

Demo Class $80

ENTRY FEES INCLUDE TRANSPONDER HIRE.

Entries close 16TH September 2019

Bank Details.

Account Name: Central Coast Junior Motorcycle Club

BSB: 082-620 Account No: 57623 1127

Event T - Shirts: Cost $35 please order on form.

Aust Junior DIRT Track ENTRY FORM if you are entering more then 3 class you need to fill in a 2nd form
First Name
Name
MA Licence No
Licence Expiry Date
Address
City and Postcode
Birthday
Club
Mobile
Riding No
Email Address
Next of Kin
Next of kin contact no
Entrant Name and MA Lic No
1st Class to enter
Bike Details make and cc
2nd Class
Bike Details Make and CC
3rd Class to enter
Bike Details make and cc
Your Transponder Number if you are using your own.
Payment details for CCJMCC
Entry Fees:
My entry fee is $
T-Shirt Order Size Required
Sponsors Details
Confirm you have read the Sup Regs
Make sure after you have hit the send button you will receive a sent message on the next page Might have to move page up to read it
Send Message

Thank you entry has been sent to Lyndel

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race secretary