Surname: First Name: Age:

Address: Phone: EMail:

MNSW race Lic No: Expiry Date:

Bike Make: Capacity: Are you a current NDMCC member? Yes:

Do you require a temporary NDMCC membership? Yes: Only required if you are not a current NDMCC member.

If you do not hold a current MNSW race licence you must purchace a one event licence please see here for online application.

Rider 2 Details

Surname: First Name: Age:

Address: Phone: EMail:

MNSW race Lic No: Expiry Date:

Bike Make: Capacity: Are you a current NDMCC member? Yes:

Do you require a temporary NDMCC membership? Yes: Only required if you are not a current NDMCC member.

If you do not hold a current MNSW race licence you must purchace a one event licence please see here for online application.

** Please note no entries will be processed until payment has been received **