Register - SA MX Nationals

Complete to Register

Account Info

Username (required) *

E-mail (required) *

Password (required) *

Password must be at least 7 characters long. To make it stronger, use upper and lower case letters, numbers and symbols.

Confirm Password (required) *

Type your password again.

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Competitor’s Information

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Competitor First Name (required) *

Competitor Last Name (required) *

Competitor Date of Birth (required) *

(required)

Primary Contact No. (required) *

Alternate Contact No.

Address (required) *

Separate registration is required for each competitor.

Account Info

Emergency Contact Name (required) *

Emergency Contact Number (required) *

MSA Licence No. (required) *

Upload License (required) *

Bike Number/s (required) *

Bike Make (required) *

Bike Model (required) *

INDEMNITY – MOTORSPORT IS DANGEROUS - I agree that MSA and/or the organising club and/or either of these bodies’ representatives or officials will not be held responsible for any loss or damage to myself, any person accompanying me, or any property of ours, and I hereby waive any right of action of law or any other means against representatives, agents or any other competitor in respect of this event or any matter arising therefrom. I declare that I have read the rules and understand the applicable SSR’s & GCR’s (including the applicable age and motorcycle classifications for each class) and I signify my agreement to abide by these rules by signing this entry form. I understand that I, the parent/guardian/competitor will be held responsible for any medical expenses incurred by this competitor during this event.

I accept the Declaration above *