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2019 AUSTRALIAN SENIOR DIRT TRACK CHAMPIONSHIP

Entry Form

5TH & 6TH OCTOBER 2019

( rain off date 7th October)

BARLEIGH RANCH

( Eagleton NSW)

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

Entry Fees:

Senior – ATV’s Class: $110 1st class $30 each extra class

Sidecars - $120 1st class.

Support Junior - $60 1st class - $20 each extra class. 

PLUS - Transponder hire of $20. for each transponder.

Bank Details.

BSB 650 000 Account No 964702701 Hunter MCC

Please remember to put riders name and # as reference. 

One Event Day Competition licenses are accepted for the following category: Under 19, 250cc Slider, 500cc Slider, Dirt Track Sidecar, ATV 450, ATV Open, ATV Open (Women) If you require a One Event License you must send an email to lyndelbutler93@gmail.com requesting the license. You will need to be a member of an affiliated club, Proof or practical competence, proof of knowledge of the rules and ambulance cover. To prove competency in riding, you will need to provide proof of holding an MA licence within the last 10 years, OR a current road licence OR proof of having attended an accredited training school, If you have not held an MA licence in the past 10 years, you will need to complete a knowledge test

Aust Sen Dirt Track Champs 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 and contact No

S/c Passengers Name

S/c Passenger Contact Details

S/c Passenger MA Lic & Exp Date

S/c Passengers address

S/c Passengers Kin's contact details

1st Class to enter

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Bike Details make and cc

2nd Class to enter

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Bike Details make and cc

3rd Class to enter

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Bike Details make and cc

Transponders needed at $20 each

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I have my own trans Number is

I am a

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ABN if professional rider

Payment details for HUNTER MCC

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Entry Fees:

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My entry fee is $ PLUS TRANSPONDER FEE $20

Sponsors Details

Confirm you have read the Sup Regs *

After you have hit the send button, the next page will advise that your entry has been sent to me. YOU MAY HAVE TO MOVE THE PAGE DOWN A BIT TO SEE THIS.

Contact Information

Keith Davies

0412 516 339

Lyndel 0411 194 315

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