Manfeild 4.5km Bent Sprint – Sunday 18th June

$130.00 – $150.00

Competitor First Name * 

Enter FIRST name of the driver
E.g. Scott

Competitor Last Name * 

Enter LAST name of the driver
E.g. Dixon

Age Group * 

Enter your age group

Class * 

Enter the class you are competing in

Civil Drivers Licence No.

Enter your NZTA civil drivers licence number (disqualified drivers are not able to enter event)

Drivers Licence Expiry Date

Enter your driver licence expiry date (exactly as written on your card)

Experience Level * 

Give us an idea of your experience on track

Car Club * 

Enter the name of the Car Club you are a member of

Car Club Member No. * 

Enter your Car Club membership number

Car Club Expiry Date * 

Enter your membership expiry date
(use format dd/mm/yyyy)

MSNZ Licence No.

Enter your Motorsport NZ licence number

MSNZ Licence Expiry Date

Enter your licence expiry date
(as written on your card)

Vehicle Make * 

Enter your vehicle make
E.g. Ford

Vehicle Model * 

Enter your vehicle model type
E.g. Escort

Vehicle Number

Enter your preferred competition number (if desired)

Number Plate

For road registered vehicles provide registration number. For non-road registered type NA.

Vehicle Colour * 

Enter your vehicle primary (main) colour

Vehicle Engine CC Rating * 

Enter your vehicle engine cubic capacity

Vehicle Log Book No.

Enter your vehicle log book number (type NA if none)

Emergency Contact Name * 

Enter the name of your contact should there be an emergency

Emergency Contact Relationship * 

What is their relationship to you?

Emergency Contact Phone * 

What is their contact phone number?

Drivers Licence Disqualified * 

Currently is your NZ civil drivers licence disqualified?

Supplementary Regs * 

I understand and agree to abide by the event supplementary regulations (found on the event page)

Indemnity & Consent * 

I agree to the MSNZ indemnity and to abide by the terms and conditions as set out for this event, available from the event page of our website

SKU: ATC-BS Category:

Description

Purchase an entry to this event as described.
Discount for MCC members.

Additional information

MCC Member

Member, Non-Member
Competition Licence Grade

C1, C1-Junior, C2, Int-C-C, Int-C-R, M-Grade, No Competition Licence, R1-Grade, R1-Junior, R2-Grade

Related products