Online Entry Form
Phoenix Motorcycle Club of SA
Adelaide 3 Hour - 24,25,26 Nov 2017
Mallala Motorsport Park
Adelaide 3 Hour Race, Mallala 75 and Mallala 50.
GP Junior Championship and GP Junior Cup

By completing this entry form you are signifying that you have read the Supplementary Regulations and know what you are doing.

To read the Supplementary Regulations, or for further information, visit our website at http://phoenixmcc.org.au

Contact for this event: Rick Dowsett on 0403 386 788
If you need to make any changes to your entry, please email: phoenixmcc@yahoo.com.au

Official SA rider grades and numbers can be found on the MSA Road Racing page at http://www.motorcyclingsa.org.au

Late Entries are open until 5pm Saturday 12th Nov.
Full payment must be verified before Wednesday 16 Nov. or your entry will be cancelled.
Note that Bank Transfer can take 3 business days.
For details about payment options, go to http://phoenixmcc.org.au/payments/
RIDER'S DETAILS
Rider's First Name
Your answer
Rider's Last Name
Your answer
Address
Your answer
Suburb
Your answer
State
Postcode
Your answer
Contact Phone
Your answer
Email
Your answer
DOB (if under 18)
If you are under 18, your parent/guardian will need to sign for you at the track.
MM
/
DD
/
YYYY
NOK Name
(Next Of Kin) name of family contact for medical emergencies
Your answer
NOK Phone
What's the best number to contact them at any time
Your answer
NOK Relationship
e.g. mother, brother, etc.
Your answer
Important Information
You have to show your Race Licence and Club Membership at sign on. If you don't have it, you can buy a $90 One Event Licence or $25 Membership from the Office.
Club Membership
What Club do you ride under?
Your answer
Grade
Your official rider grading. If you have not been notified of your grade, then you are D grade.
P Plate
Please check box if entering Bracket Racing under the P Plate Eligibility Rules
Riders MA Licence No.
Leave blank if purchasing a One Event license in 'Other Fees'. Make a note in Comments if you have applied for a MA Licence but haven't received it yet.
Your answer
Riders MA License Expiry Date
MM
/
DD
/
YYYY
Entrant or Sponsor
NOTE: max 30 characters allowed in program. If it's too long we will shorten it, so put your main sponsor first!.
Your answer
3 HOUR TEAM DETAILS
Only use this section if you are entering the 3 Hour race.
3 Hour Team Name
This will allow us to match the other members of your team.
Your answer
Team Category
What type of team are you?
ENTRY DETAILS & FEES
3 Hour Teams: All riders in a team must use the same 2 digit riding number. You will then be issued with a A,B,C letter at sign on. Your riding number (e.g. 99A,99B,99C) will be used for the entire weekend.
Please tick Yes where applicable. (Tick None if you made a mistake)
Yes
No
$200 - Rider Fee (ALL RIDERS)
$120 - Friday Ride Day
$40 - Recreation License (Friday)
$90 - One Event License (for Sat/Sun)
$20 - Transponder fee for Bike 2
$20 - Transponder fee for Bike 3
$25 - Phoenix Club Membership
Bike 1
What bike are you riding? Enter the Make and Capacity (also the year if C20 or C20+)
Your answer
Bike 1 Riding Number
MAKE SURE YOU READ THE SUPP REGS. We will confirm your race number in your Final Acceptance. 3 Hour Teams: All riders in a team must use the same 2 digit riding number.
Your answer
Bike 2
If cross entering some events on a second bike, use this section, otherwise leave blank. NOTE: Your Rider Fee includes the transponder for Bike 1. You will need a second transponder for this bike (see above Fees).
Your answer
Bike 2 Riding Number
Your answer
Bike 3
If cross entering some events on a third bike, use this section, otherwise leave blank. NOTE: you will need a third transponder for this bike (see above Fees).
Your answer
Bike 3 Riding Number
Your answer
What Classes are you entering?
Tick your Classes and pay the Entry Fees shown. NOTE: if you enter multiple classes you may have some back to back races. (tick the None if you made a mistake)
Bike 1
Bike 2
Bike 3
None
$150 - Adelaide 3 Hour
$70 - Mallala 75
$50 - Mallala 50
$50 - Superbike
$50 - Supersport
$50 - Pre Modern
$50 - Naked Bike
$50 - Limited
free - GP Junior Champs
free - GP Junior Cup
free - Junior Relay
Total Fees
Please add up all your fees and put the total here. Total Fees include GST and applicable rider levies.
Your answer
Payment Method
Instructions for paying by Card or Bank Transfer are on our website.
Important Information about Your Payment
We will confirm your Entry details and Fees by email within 24 hours. Please wait for that email and check your fees before you pay.

CARD PAYMENTS are verified immediately through our Paypal account (Note:you do not need a PayPal account to use this)

BANK TRANSFER can take up to 3 business days to verify.

Any OUTSTANDING FEES (including Bank Transfers) must be received by the club before sign in or YOU WILL NOT RIDE. Cash only at the track, the nearest ATM is at Mallala.

ABN Number
Professional riders only, otherwise leave blank. Note: the Phoenix Motorcycle Club is the holder of ABN 70 145 377 567
Your answer
Comments
Is there anything you want to tell us about your entry?
Your answer
Anti Spam Question
Prove you are not a robot. Using your number keys, put the number four in the box below
Your answer
PLEASE don't come to the track alone. Motorcycle racing is hazardous and you will need someone to get your bike and car home if you cannot drive. Fuel is not available at the track. There is no ATM at the track. Make sure you read the Supp Regs and Race Schedule.
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