Owen Levy Memorial DayDate DD slash MM slash YYYY Rider InformationRider's Name* Race Number* MA Lic. No Exp. Age Do you require a DAY LICENCE or REC LICENCE? (state which one)Which class/classes will this rider enter?* 50cc Demo Division 1 (4-U9) 50cc Auto Division 2 (7-U9) 65cc 85cc 2/ & 150cc 4/ SW 85cc 2/ & 150cc 4/ BW Up to 85cc 4/ modified Up to 85cc 4/ standard 100cc 2/ to 150cc 2/ (13-U16) 200cc to 250cc 4/ (13-U16) PRO Open (Restrictions may apply) PRO All Powers (Restrictions may apply) 50cc Demo Division 1 (4-U9)Grade*OPENBike* (Make & Capacity)50cc Auto Division 2 (7-U9)Grade*OPENBike* (Make & Capacity)65ccGrade*ABCBike* (Make & Capacity)85cc 2/ & 150cc 4/ SWGrade*ABCBike* (Make & Capacity)85cc 2/ & 150cc 4/ BWGrade*ABBike* (Make & Capacity)Up to 85cc 4/ modifiedBike* (Make & Capacity)Up to 85cc 4/ standardBike* (Make & Capacity)100cc 2/ to 150cc 2/ (13-U16)Grade*ABBike* (Make & Capacity)200cc to 250cc 4/ (13-U16)Grade*ABBike* (Make & Capacity)PRO Open (Restrictions may apply)Grade*OPENBike* (Make & Capacity)PRO All Powers (Restrictions may apply)Grade*OPENBike* (Make & Capacity)Costs & AcknowledgementsYour first class is $45, your second class is $20, and third/fourth classes are $15 each. The family cap is $130. Additional costs: Day Licence: $75 Rec Licence: $30 Transponder Hire: $32 Membership: $120 Practice: $30 Mid-Week Practice: $15I acknowledge that this meeting will be held in accordance with the current general competition rules (moms), the supplementary regulations (of which this entry form forms a part of) and any final instructions. By entering this meeting all parties agree to comply with these rules, regulations, by-laws and instructions.Parent/Guardian or Senior SignatureName First Last Phone EnquiriesFor all enquiries, please email the Club Secretary at secretary@mikehatcherjmcc.com.auNameThis field is for validation purposes and should be left unchanged.