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BRISBANE MCC

presents

CLUD DAY MX RD 3

on

Sunday 27th OCTOBER

at

MICK DOOHAN RACEWAY

NUDGEE MX track

Please read sup regs before filling out this on line entry form click here

Fill in all details below and select which classes you are riding then bike details.

You must put in a email address.

If you are entering more then 5 classes pleas just fill out another form after you have sent the first form.

Then pay the entry fee into the club account details below

Entry Fee Solo's $60 First Class + Extra classes at $15 per class + $25 transponder hire

Sidecars $80 + $25 transponder hire.

PAY ENTRY FEE TO CLUBS BANK ACCOUNT

Payment Details.

Bank: Bank of Queensland

BSB : 124--020 Account Number: 101630029 Account name: Brisbane MCC

Club MX Rd 3

First Name

Name*

MA Licence No

Licence Expiry Date

I need a Day Licence please go to ridernet for day licence

Address

City and Postcode

Birthday

Club

Mobile

Riding No

Email Address*

First class to enter

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Bike Details make cc year

2nd Class to enter

arrow&v

Bike Details make cc year

3rd Class to enter

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Bike details Make cc year

4th Class

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Bike details Make cc year

5th Class

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Bike details Make cc year

I am a member of Brisbane MCC

ENTRY FEE Solo $60 extra classes $15 Sidecars $80. Plus $25 each transponders required

Pay fees into clubs account BSB 124-020 Account no 10163029

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

Contact Information

Lyndel

0411 194 315

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