Email form page for section 'mg-classic-entry'

Driver First Name *

Driver Last Name *

Street Address *

Suburb

City *

Telephone *

Email Address *

Age Group *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone *

First Time Driver? *

Yes, 3 or fewer race events completed
No, 4 or more race events completed

New Competitor to Manfeild? *

Yes
No

Foreign Participant on Non-NZ Race Licence? *

Yes
No

Class Entered

Vehicle No. *

Vehicle Make *

Vehicle Model *

Vehicle Colour

Vehicle Year *

Capacity in cc *

Certificate of Description (schedule K or T&C where applicable)

Log Book No. *

Car Club *

Club Membership Expiry Date (dd/mm/yyyy) or Life Member *

Race Licence Number *

Licence Grade *

C1 - National Race
C2 – National Race
C International Race Grade C

Licence Expiry Date (dd/mm/yyyy) *

NZ Civil Drivers Licence is current *

Yes
No

Supplementary Regs - I understand and agree to abide by the event supplementary regulations *

Yes I agree

Indemnity & Consent - I agree to the MotorSport New Zealand indemnity and to abide by the terms and conditions as set out for this event *

Yes I agree

Vehicle Conformance – I declare that the vehicle complies with vehicle safety items as set out for this event *

Yes I agree

NOTE: The entry fee for Lady Drivers who compete in the Sybil Lupp Trophy race, South Island Residents and MG vehicles is free if entered before 20th October 2022 otherwise entry is $375

Entry Fee $375

Late Fee $40 (if after 20th October)

Optional Donation to charity (Cancer Society or Kara Hands Charitable Trust)

Extra weekend Entry Passes @ $10 (drivers receive 4 entry passes Free)

TOTAL

Which image is the Umbrella?

   

Date of Meeting: 11th, 12th, 13th, November 2022
Circuit: Manfeild Circuit, Feilding

Entry Form MG Classic

Support our Supporters

MG Wellington are Proud Sponsors of:

Copyright © MG Car Club New Zealand

Date of Meeting: 11th, 12th, 13th, November 2022 Circuit: Manfeild Circuit, Feilding

Entry Form MG Classic

Support our Supporters

MG Wellington are Proud Sponsors of:

Copyright © MG Car Club New Zealand

Date of Meeting: 11th, 12th, 13th, November 2022
Circuit: Manfeild Circuit, Feilding