Rider Details			Classes
Last Name:	*		Supercross	$	X
First Name:	*		Supercross Lites	$90
Email:	*		Supercross Open	$90
Mobile #:	*
Postal Address:	*
Town / City:	*
Age on Race day:	*		JUNIOR's	$	X
Date of Birth:	*		Junior Lites	$90
Racing #:	*		Junior 125/250 four stroke	$90
Bike Make/Model/CC:			Junior Support   (Non Championship class - limited to first 10 entries)	$50
Personal Transponder#:
MNZ License #:
Sponsors:
			SENIOR's	$	X
Date:			Senior Support   (Non Championship class - limited to first 10 entries)	$50
(If rider is under 16 years of age)
Parent/Legal Guardian:
Relationship:
Note on Transponders If personal transponder is supplied you must supply your transponder number
			Extra Persons Entries
			Number reqd $             Adults $20 ea Children $5 ea Pit Passes             $10 pp Total
			SUBTOTAL	$
			Late Entry Fee if you are entering after 13 January, 2012. $50
			TOTAL PAYMENT	$