ON LINE ENTRY FORM AVARD SUPERMOTO PROMOTIONS PRESENTS The WESTERN QBE Moto Mayhem
I have read the Supplementary Regulations and will sign a acknowledgment and Participant Declaration Forms at Sign-On. When a drop down button is in place please make your selection. When you have filled in On Line Entry form click the Send Entry button
Payments:
1. Direct Banking Details - BSB:032524 ACCN:146517 ASM Promotions
2. Credit Card Payment by phone or SMS only 0411194315
ON LINE ENTRY FORM FOR THE WESTERN QBE Moto Mayhem
The Clerk of Course Craig Johnson.
The MA Steward Tim Sanford & Ian Parker. Permit No 18026
DOWNLOAD SUP REGS HERE
Riders Name:
Address:
City / Town: Post Code:
Phone: Work: Mob:
Email: D.O.B
Next of Kin Next of Kin Phone Number
MA License Number: Expiry Date:
Entrant Name: MA Entrant No: Expiry Date:
Riding Number: Registered? Yes No
Bike 1 Details: Make: Model: CC:
Bike 2 Details: Make: Model: CC:
Choose (Select Box) a Single Event For the Price Indicated then Each Additional Event will cost $50
One Event Licence (ONLY FOR CLASSIC MX Competitors)
OR You can choose (Select Box) up to 3 events for only $200, to qualify for the Iron Women or Man competition you must enter a feature race.
Entry Fees: Supermoto $100 EnduroX $80 Motorcross $80 Pitbikes $80 EVO $80 Iron Man / Woman or 3 Classes $200
Payment: Credit Card (Fee $5) - Please Ring Direct Deposit - BSB:032524 ACCN:146517 ASM Promotions
Credit Card payment by phone only 0411194315