2009 Manual of Motorcycle Sport - Motorcycling Australia

APP 2 MODEL SUPP REGSenjoy the ride [INSERT EVENT NAME][INSERT DAY & DATE][INSERT VENUE][INSERT PROMOTER /CLUB LOGO HERE]ENTRY FORMEntries Close: [Insert closing date of entries] Offi ce Use Only:Send to:[Insert contact name]Allocated Rider No:[Insert address][Insert City/Town, Postcode, State][Insert number and/or fax]RIDER DETAILSRider’s First Name: _______________________ Rider’s Surname: _______________________________Address: ______________________________________________________________________________City/town: _______________________________ State: ____________________ Postcode: ___________Tel: ______________________________ Mob: ______________________________________________Date of birth: _______________________ E-mail: _____________________________________________Next of Kin: ___________________________________________ Next of Kin Tel: ___________________MA Lic. No.: _____________________________ Expiry Date: _______________ Grade: ____________1st Preferred number plate: _________2nd Preferred number plate: __________PASSENGER DETAILS (SIDECAR ONLY)Passenger’s First Name: ___________________ Passenger’s Surname: ___________________________Address: ______________________________________________________________________________City/town: _______________________________ State: ____________________ Postcode: ___________Tel: ______________________________ Mob: ______________________________________________Date of birth: _______________________ E-mail: _____________________________________________Next of Kin: ___________________________________________ Next of Kin Tel: ____________________MA Lic. No.: _____________________________ Expiry Date: _________________ Grade: ___________Must be completed by all competitors/entrantsI/we are completely aware of the mechanical and electrical specifi cation of the motorcycle which I/we have entered inthis event and guarantee that this motorcycle conforms with all rules stated in the GCR’s of MA and these SupplementaryRegulations.Rider’s Name: ____________________ Signature: _______________________ Date: _________________Entrant’s Name: __________________ Signature: ______________________ Date: _________________RIDER MACHINE DETAILS1st Bike - Make/Model & Capacity _______________ 2nd Bike – Make/Model & Capacity: _____________3rd Bike – Make/Model & Capacity: ______________ 4th Bike – Make/Model & Capacity: ______________248