DON’T JUST RIDE IT...
RACE IT !!
MOTO RIDER ACADEMY
RACE CLUB
[email protected]
www.mratraining.co.za
057 355 6519
126 Constantia Road
Dagbreek
Welkom
9459
Official 8 HOUR Race Entry Form (Each rider
in 8 hour team must complete the entry and indemnity form)
NAME & SURNAME:
CELL:
ID NO:
DATE OF BIRTH:
ADDRESS:
WOMZA LICENSE NO :
E-MAIL:
BIKE MAKE & CC:
NEXT OF KIN:
EMAIL:
NEXT OF KIN CONTACT DETAILS:
TEAM NAME:
PLEASE SELECT WHICH CATEGORY YOU WISH TO ENTER MRA GP
MRA GP LAP TIME P/GROUP
GROUP
1:54 - maximum lap time
A
B
C
2:00 - maximum lap time
D
1:43 - maximum lap time
1:48 - maximum lap time
MRA SBK LAP TIME P/GROUP
GROUP
1:58 - maximum lap time
A
B
C
2:03 - maximum lap time
D
1:48 - maximum lap time
1:53 - maximum lap time
IF AVAILABLE
PIT ALLOCATION :
OR MRA SBK
- AND COMPLETE THE FOLLOWING:
X
RIDER NAME AND SURNAME IN EACH GROUP
MEDICAL DETAIL member number
X
RIDER NAME AND SURNAME IN EACH GROUP
MEDICAL DETAIL member number
Team Entry Fee for Phakisa 8 Hour Endurance Race on the 8/9 th of August 2015 at Phakisa R 2800.00
Rules and Indemnification
Please Note the following RULES, you may be excluded from the event with no refund if you do not adhere to the rules stipulated below.
Booking is not confirmed until payment has been received. In case of rain, or natural disasters, NO monies will be refunded.
Participants MUST supply their own protective clothing (only 1 Piece full leathers will be permitted for racing),incl helmets, gloves and
rider boots. Bikes of participants must be in proper working condition and will undergo a check by the organizers. If the bike is found not to be in a good
working condition or the tyres are worn then the participant will be excluded and no money will be refunded.
The Bikes must have oil filter and oil cap plus front brake calipers must be lock wired.
No dangerous and reckless overtaking or bumping, pushing will be allowed. A safe distance must be given to other riders when overtaking.
Riders may not push each other wide on the exit of a turn. Pit lane speed is 40 kilometres per hour, pit lane direction is as per track direction, participants
may not stop on track, no stunts incl wheelies are allowed, not on the track nor in the pit complex. Riders may not consume or use alcohol or any other substance
which could cause any medical condition.
No rider may ride on track or anywhere in the facility on any motorcycle without a helmet. Riders must indicate when exiting the track and riders must
follow flag rules.(On signing this form you agree to abide to all WOMZA circuit rules) Any Rider failing to adhere to these rules or riders found guilty of misconduct
will be excluded from the event and will be either suspended temporarily or permanent from Club depending on the severity of the grievance.
Riders may not go faster than allocated and permitted minimum lap times in the groups they entered for the 8 hour. If a rider goes faster than the allowed allocated
minimum lap time then one penalty lap will be DEDUCTED from teams overall laps completed. No Rider may swap and ride in another group or team.
Transponders must be fitted to riders boot who entered the specific group. Transponder may not be
fixed to bikes. Teams must adhere to safety regulations, if told that the tyres are not safe and need to be changed then the teams must adhere and follow the instructions
on the next compulsory pit stop. Pit Stops are compulsory in between sessions and shall be indicated by a chequered flag boards with one half yellow.
The end of the race will be indicated with a white and black chequered flag only. No bike/rider may use lap timers on the bikes, nor the use of the bikes own lap timing system.
The undersigned participant does hereby execute this release, waiver and indemnification for himself and his/her/their heirs, successors,
representatives and assignees and hereby agree(s) as follows: To release Moto Rider Academy, Moto Rider Academy Club, Members, Womza, Clerk of
the Course, Medical personnel and their governing body the organiser and founder of the club Donald Andre Neethling, it's representatives,
sponsors and or any other participating individual/instructor, Phakisa Freeway, Free State Tourism, it's governing body, it's members, employees,
agents, representatives and those governmental agencies affiliated with this event from any and all liability, not limited to all bodily injuries and
property damage arising out of participation in the course referred to above, it being specifically understood that the said event includes the
operation and use by the undersigned participant and others on motorcycles in a Club racing 8 hour endurance event permitted and sanctioned by
Womza world of motor sport.
This indemnification shall include all attorney fees incurred in defending against any claim or judgement agreed that the undersigned
shall have the opportunity to consent to any such settlement, provided, however, that such consent shall be reasonably withheld.
The participant agrees to abide by the safety rules of the event and agrees not to undertake any action not included in the event as set out in the rules.
Further more all ambulance and medical assistance will be for the participants account. By Signing this release waiver and indemnification entry form
the undersigned acknowledge and confirm that the undersigned is in good health and is fit to participate in motorcycle racing activities. It is clearly
understood that racing is dangerous and insurance may not cover medical or property damage or loss during racing. It is agreed by the undersigned that
no claims can be made for any damage or medical cost/insurance regardless of the incident whether self inflicted or caused by negligence of organisers
or other parties including other participants on or off the race track during said event.
Moto Rider Academy
Branch Code 055535
Acc: 281782741
FAX: 057 355 6516
[email protected]
PLEASE SUBMIT PROOF OF PAYMENT
A 30 % DEPOSIT ( R840,00 ) IS REQUIRED TO
SECURE YOUR TEAMS BOOKING
MAX 30 TEAMS ALLOWED.
I THE UNDERSIGNED HEREBY AGREE TO ALL THE RULES, TERMS AND CONDITIONS OF THIS ENTRY FORM.
Please send Proof of own Medical if you do not wish to take out WOMZA Medical cover. ( You hereby confirm your medical will cover you during this 8 hour racing event)
DATE
SIGNATURE OF PARENT/GAURDIAN IF RIDER IS A MINOR
INCLUDING NAME AND SURNAME OF RIDER/ENTRANT WHO WILL PARTICIPATE IN RACING.
Standard Bank
TEL: 057 355 6519
RELEASE WAIVER AND INDEMNIFICATION
SIGNATURE OF RIDER WHO WILL PARTICIPATE IN RACING.
BANKING DETAILS