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2019 QLD CLASSIC MX CHAMPIONSHIP

2ND JUNE 2019

ON LINE Entry Form 

MICK DOONHAN RACEWAY 

NUDGEE

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

Entry Fees:

– 1. ENTRY FEE:

Senior Class: $85 1st class $15 each extra class

Sidecars: $110

Note the Age group's will be run with the cc class race and will not cost extra to enter but if you will need to enter the cc class first.

Entries close: OPEN TILL THE 29th MAY

Bank Details.

BSB 124020 Account No 10163029 Brisbane MCC

Please remember to put riders name and # as reference. 

IF YOU ARE ENTERING MORE THEN 3 CLASSES PLEASE FILL IN SECOND 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

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

Enter in AGE GROUP

AGE CLASS

IF YOU ARE ENTERING MORE THEN ONE CLASS PLEASE PUT DETAILS IN NEXT BOX

FOR EXTRA AGE CLASS

I am a

ABN if professional rider

Payment details for Macleay Dis MCC

Entry Fees:

My entry fee is $

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

Contact Information

Lyndel 0411 194 315

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