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2009_competitor_licence_app_190209

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					                                    MOTORCYCLING NSW LIMITED
                                                ACN 096 875 526 - ABN 20 096 875 526

                                          PO BOX 9172, HARRIS PARK NSW 2150
                                          Phone: 02 9635 9177 Fax: 02 9635 5277
                            EMAIL: mnsw@motorcycling.com.au WEBSITE: www.motorcycling.com.au


                        2009 LICENCE APPLICATION
                    Please read the notes below before completing your application.

LICENCE TESTING: Licence testing is compulsory for ALL first                                  LICENCE TYPE:                 FEES:
time senior and junior applicants. This can be completed                               Mini                                 $85.50
through your club.                                                                     Junior Club                          $215.00
MINI LICENCES: For all junior non competitive licence holders                          Junior National                      $240.00
(Replacing Nipper and Junior Restricted National). This can also                       Senior Club                          $230.00
be used for participants 4 to 15 years of age who are solely                           Senior National                      $265.00
competing in Minikhana.                                                                Senior Restricted National           $175.00
JUNIOR LICENCES: May be issued to rider’s ages 7 to 15                                 Recreational                         $85.50
years.                                                                                 Entrant                              $55.00
SENIOR LICENCES: May be issued to riders who are 16 years                              Speedway Mechanic                    $16.50
or older.                                                                              One Event National                   $77.00
CLUB LICENCE: Used for practice days, Closed to club and
Inter club meetings.                                                                        LICENCE UPGRADE:                FEES:
NATIONAL LICENCE: Valid for practice days, Club, Interclub                             Mini – Junior Club                   $140.50
and Open meetings                                                                      Mini – Junior National               $165.50
RESTRICTED NATIONAL LICENCE: For riders 16 years and                                   Mini – Senior Club                   $155.50
over. Only for use in Moto Trials, Mini Moto or Fast 50’s.                             Mini – Senior National               $190.50
RECREATIONAL: For riders 16 years and over. This licence                               Junior Club – Junior National        $36.00
can not be use for racing.                                                             Junior Club – Senior Club            $26.00
ENTRANTS: A person or corporate body must have this licence                            Junior Club – Senior National        $61.00
to enter a rider in any competition.                                                   Junior National – Senior Club        $21.00
SENIOR AND JUNIOR SPEEDWAY LICENCES: Must be a                                         Junior National – Senior National    $36.00
National licence and have completed the speedway theory and                            Senior Club – Senior National        $46.00
practical test. Only for 9 years and above.                                            Restricted – Senior Club             $66.00
SUPERCROSS: Must have a national licence then pass a                                   Restricted – Senior National         $101.00
Supercross school. The coach must be a level 2 Supercross                              Recreational - Senior Club           $155.50
Coach. Only for 12 Years and above.                                                    Recreational - Senior National       $190.50
JUNIOR ROAD RACE: Riders aged 13 Years and above may                                   Recreational - Restricted National   $100.50
have their licences endorsed after being assessed by a MNSW
Junior Road Race assessor.                                                              CREDIT CARD SURCHARGE               $5.00
QUADS AND SIDECAR PASSANGER: Quads and Sidecar
passenger applicants must complete a further discipline
practical and theory test with a MNSW Testing officer.                                            PLEASE NOTE:
ONE EVENT NATIONAL: Valid for Historic only. Availability                               LICENCES ARE NOT ISSUED OVER
should be in supp reg’s.                                                                THE COUNTER – PLEASE DO NOT
PHOTOGRAPH: All applicants are required to supply 1 passport                              ASK AS REFUSAL MAY OFFEND
sized photo with each application.
REGISTERED RIDING NUMBERS: Can be registered each
calendar year for a fee of $15.00 per number per discipline.


     YOU MUST ALLOW 14 DAYS FOR PROCESSING THIS DOES NOT INCLUDE POSTAGE.
   ONCE A LICENCE HAS BEEN PROCESSED A FULL OR PART REFUND WILL NOT BE ISSUED.
                                           PROHIBITED SUBSTANCES:
       Under Motorcycling Australia’s current anti-doping policy all athletes who participate In motorcycle sport
  conducted under the auspices of MA must have prior written approval from a recognised authority in order to be
                                      permitted use of a prohibited substance.
    If you use a prohibited substance please contact Motorcycling NSW on the number listed above to obtain a
  RESTRICTED USE OF A PROHIBITED SUBSTANCE FORM. If in doubt refer to the ASDA DRUGS IN SPORT
                                                hotline 1800 020 506.
                             MOTORCYCLING NSW LIMITED
                                             ACN 096 875 526 - ABN 20 096 875 526

                                    PO BOX 9172, HARRIS PARK NSW 2150
                                    Phone: 02 9635 9177 Fax: 02 9635 5277
                      EMAIL: mnsw@motorcycling.com.au WEBSITE: www.motorcycling.com.au
                                                                                                          Please ensure your
                    2009 LICENCE APPLICATION                                                                  photo will fit
  New           Renewal        Upgrade   From__________________ to _____________________                    inside this box.
                                                                                                            Please DO NOT
 Mini                          Junior Club                           Junior National                       stick your photo
                                                                                                                 down.
 Senior Club                   Senior National                       Snr Restricted National

 One Event National            Speedway Mechanic                     Senior Recreational


MA Licence Number:                                                         Expiry Date:

First Name:                                                                Surname:

Address:

Suburb:                                                                    State:                      Postcode:

Email Address:

Phone Number:                                                              Mobile Number:

Sex:    Male     Female                                                    Date of Birth:

Next of Kin:                                                               Relationship:

Name of Club:

Ambulance Fund:

Policy Number:                                                                      Expiry Date:

                                         PREFERRED DISCILPINE:
   Motocross              Dirt Track            Minikhana                   Enduro
   Fast 50’s              Moto Trials           Mini Moto                   Road Race
   Super Moto             Historic Road Race    Classic Track               Classic MX
   Supercross*            Speedway*             Junior Road Race*           Quads*
   Sidecar Rider*         Sidecar Passenger*    Freestyle Motocross*
                   * ENDORSEMENTS (Make sure you have completed the required information)
  Up to 200cc 2 St        Up to 250cc 4 St      Supercross                  Speedway
  Sidecar Passenger       Junior Road Race      Freestyle Motocross         Quads
                                ARE YOU SUPERCROSS ENDORSED? YES NO
                IF YES PLEASE MAKE SURE YOU FILL OUT THE SUPERCROSS RENEWAL FORM ATTACHED.
               PAYMENT DETAILS:        AMOUNT PAID $...................................................... Cheque/Money Order
                OR DEBIT:           VISA                    MASTERCARD                      Expiry Date: ______/_______




Account Name:                                                                  Signature:


Processed:                                                                     Receipt Taken:
                                                                               Receipt Number:
               RENEWAL OF SUPERCROSS ENDORSMENT
              ATTENTION ALL SUPERCROSS ENDORSED COMPETITORS:


            IF YOU DO NOT COMPLETE THIS FORM AND RENEW YOUR
          SUPERCROSS ENDORSMENT IT WILL BE REMOVED FROM YOUR
                                LICENCE.



     Please complete the following details and return with your licence application:


Name:                                          Licence number:

         I have completed in the following Supercross meeting in the last 12 months:

Date of meeting:
Name of Meeting:
Venue:
Class:


I acknowledge that I must compete in at least 1 Supercross meeting each year to enable
                       me to keep my Supercross endorsement.




Signed:                                       Date:
                      IMPORTANT: READ THE FOLLOWING INFORMATION AND SIGN WHERE SPECIFIED:

      You need to complete this application and return to the MNSW Office as soon as possible.
      Exemptions/Clearance letters will NOT be issued.
      Any rider competing without a licence or signing a False Declaration can be suspended for up to 2
    years.
      Telephoning the office inquiring about the progress of your licence will only further delay its return.

MEDICAL DECLARATION:
I am unaware I have any medical condition which may endanger the wellbeing of myself or others during any motorcycle
activity. I authorise any Hospital, Medical Practitioner, Paramedic or First Aid Service to furnish to MA any information relevant
to any injury I may suffer during sanctioned activity. I undertake to provide a Medical Clearance to the SCB before participating
again if I am hospitalised. I understand it is compulsory for me to have Ambulance Insurance in some form and I accept
responsibility for the cost of ambulance transportation.
PRIVACY DECLARATION:
MA and the SCB’s require the information requested in this form to provide you with membership services. Your personal
information will only be used in accordance with the objects of MA and the SCB, MA and SCB general business and to provide
you with membership services. Your details may, for example, be forwarded to event promoters and other related MA and SCB
parties. You will be able to access your personal information through MA or the SCB upon reasonable notice. If the requested
information is not provided you will not be able to receive membership services.
     I understand that if I compete at NSW state title events, my results for such events will be published on the MNSW website.

STATEMENT:
I agree to be bound by the Constitution, Rules, Regulations and By-Laws of Motorcycling Australia and relevant SCB’s. I also
acknowledge and agree as a condition of participation in any MA sanctioned activity that neither MA or any of the entities or
individuals involved in the conduct of its business, shall be under any liability for my death, or any bodily injury, loss or damage
which may be sustained or incurred by me as a result of participation in said activity except in regard to any rights I may have
arising under the Trade Practices Act 1974. I acknowledge motorcycle sport is dangerous and that accidents causing death,
bodily injury, disability and/or property damage can and do happen. I have read and agree to the terms and conditions set by
Motorcycling NSW Limited for my licence application.

Applicant Signature:                                                                                  Date:

  CONSENT STATEMENT FOR APPLICANTS UNDER THE AGE OF 18 YEARS TO BE SIGNED BY PARENT/GUARDIAN


I…………………………………………………………..….(Print full name) being the parent/legal guardian of the above-named
applicant have read the whole of this document and consent to their participation in Motorcycling Australia sanctioned activities.
I acknowledge that motorcycle sport is dangerous. I agree that neither Motorcycling Australia nor any of the entities or
individuals involved in the conduct of its business, shall be under any liability whatsoever for any death, bodily injury, loss or
damage. Whether such death, bodily injury, loss or damage is caused by negligence or otherwise, except in regard to any
rights I may have arising under the Trade Practices Act 12974. I acknowledge that disciplinary action may be taken against the
applicant of this licence if I, or any associated party to the applicant are found to breach the General Competition Rules as
outlined in the Manual of Motorcycle Sport.
Full Name:                                                               Signature:
Address:                                                                                                  P/Code:
Date:                                                                 Parent or Legal Guardian (Delete One)
                                                    LICENCE APPLICATION CHECKLISTS
                                                                                                                   UPGRADE OF LICENCE
                                                            RENEWAL OF LICENCE CHECKLIST                  Completed Application including Ambulance
            NEW LICENCES – CHECK LIST                      Completed Application including              details
   Completed Application including Ambulance details     Ambulance details                                1 Passport Photograph
   Copy of Club Membership Card                            Copy of Club Membership Card                   Correct Payment
   1 Passport Photo                                        1 Passport Photo
   Correct Payment                                         Correct Payment
   Copy of Birth Certificate, RTA Licence or Passport      Copy of Logbook with 5 hours of Coaching
   Theory Test (Minis/Juniors - Kick Start Booklet       (Minis/Juniors Only)
Assessment 2 or JCP Logbook)                              SPEEDWAY MECHANICS – CHECK LIST                APPLICANTS WISHING TO UPGRADE FROM
   Completed Practical Test or copy of RTA Motorcycle      Completed Application Form                   MINI TO JUNIOR, MINI TO SENIOR OR JUNIOR
Licence (Minis/Juniors – Kick Start Booklet Assessment     1 Passport Photograph                         TO SENIOR MUST SUPPLY THEIR CURRNT
1 or JCP Logbook                                           Correct Payment                                LICENCE WITH THIS APPLICATION FORM.
                                                           Form of ID (Only for new applicants)

				
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posted:3/22/2013
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