ALTERNATIVE TO ONLINE LICENCING

RENEWAL OF COMPETITION
Licence Application 2022/2023

Phone: +64 7 828 7852 Motorcycling New Zealand Inc.

Email: admin@mnz.co.nz Postal: PO Box 253, Huntly 3740
Courier: 211 Main Street, Huntly 3700

PLEASE NOTE: Should any part of this form be incorrect or incomplete, it will be returned back to you for completion.
For prompt return of your licence please ensure that you have completed all details required. Allow up to 14 working days for processing.

Do you hold a competition licence with a Motorcycle Federation in another country? YES NO
If ‘Yes’ please supply a letter clearing you from all obligations in order for you to obtain an MNZ licence.
You can only be a member of one country recognized by the FIM at any one time.

MNZ Licence No.

MNZ Affiliated Club Expiry Date

Family Name First Name(s)

Address

Postcode

Home Phone Work Phone

Fax Mobile

Email

Date of Birth Age Male Female

Please complete this application to be eligible for a Family Discount, Free Licence if 65 years or over or if you are unable to licence online.

LICENCE TYPE PLEASE READ CAREFULLY AND TICK ONE LICENCE TYPE ONLY.

CHAMPIONSHIP LICENCE - required for New Zealand, North Island, South Island Championships & Street Road Race.
Also valid for all MNZ Permitted Club Events. Senior ($183.75) Junior ($183.75)

ATV ($138.75) Junior Senior Trial ($138.75) Junior Senior

Over 65 yrs (FREE)

CLUB LICENCE Mini Junior Senior $105

Required for all other MNZ Permitted Events. Discounted for 1st time applications or if you have not held a MNZ Licence for 3 years.
If you are competing at a Championship Event in a support class (not for a championship title) the club licence will suffice.

ASSOCIATE LICENCE - Associate Member; non-competitive $70

This licence allows you to ride at 2 club events. This membership is entitled to vote.

MANUAL OF MOTORCYCLE SPORT - Please tick one box.

Copy of the MNZ Manual of Motorcycle Sport $20

I will undertake to read these provided on the MNZ website - www.mnz.co.nz

POSTAGE F.O.C. COURIER $10 - Standard Delivery $14 - Rural Delivery

DISCOUNTS - Individual forms must be completed for each member.

• Discounts will be given to competitors from one family (same address) licencing at the same time.
| 2 members 10% | 3 members 15% | 4 or more members 20%

www.mnz.co.nz
PAYMENT DETAILS
Payment in Full by: Direct Credit | Credit Card (Circle one)

$ Licence Fee Direct Bank Credit Account: Motorcycling New Zealand Inc.
ANZ, Huntly 06 0329 0008518 00
$ less discount
(Please add your MNZ Licence Number or Surname & Initial in Reference)
$ Manual
Credit Card: VISA MASTERCARD
$ Courier
- - -
$ TOTAL Card No: Credit card transaction fee will apply 3% per transaction
Card Account Name: Expiry Date:
$ TOTAL PAID
Amount: $ Signed: Date:

CLASS & RACING NUMBER REQUEST

Your MNZ allocated number, as shown on your licence card, must be used when entering and competing in all events.
Please tick the class/es you require an MNZ allocated number in: Numbers you prefer if available.

JUNIOR MOTOCROSS ATV

Please tick which of the following you ride in:
8-11 yrs 65cc Junior Senior Please note MNZ do not hold numbers for these classes.
8-11 yrs 85cc & 150cc Beach Racing Classic
CROSS COUNTRY
12-13 yrs 85cc & 150cc Enduro Longtrack Racing
Junior Senior
14-16 yrs 85cc & 150cc Miniature Road Race Trial
12-14 yrs 125cc SENIOR MOTOCROSS Pit Bike Post Classic
15-16 yrs 125cc MX1 MX2 Street Stock Supercross
MX 125cc Veteran Super Motard Trail Rides
14-16 yrs 150cc & 250cc
Women’s
JUNIOR WOMEN’S MX MINI MOTOCROSS
8-11 yrs 85cc & 150cc Intro Trail (4-7 yrs, 50cc) MX 65cc (9-11 yrs)
ROAD RACE
Intro MX (4-7 yrs, 50cc) Trail (7-9 yrs)
12-16 yrs 85cc & 150cc To keep/apply for a Road Race number,
you must complete the application form MX 50cc (6-8 yrs) Trail (8-11 yrs)
12-16 yrs 125cc & 250cc attached. MX 65cc (7-8 yrs)

HEALTH & DISABILITY DECLARATION MINI TRIAL

Minis 1 4-7 yrs
Doctor’s Name Phone
Minis 2 8-11 yrs
Doctor’s Phone Minis 3 12-14 yrs

Have you been treated for, or do you have any of the following?
YES NO
Nervous breakdown, mental disorder
Head injury with unconsciousness or concussion
Heart disease or disorder
High blood pressure, anaemia or blood disease
Diabetes
Dizziness, fainting spells, fits or blackouts
Do you have any eyesight abnormalities we should be aware of?
Have you any abnormality to any part of the upper or lower limbs?
* If you have answered YES to any of the above,
please supply a medical clearance which states that you are medically cleared to compete in motorcycle racing.
Allergic reactions
Asthma Brand of Inhaler
Are you required to wear glasses/contact lenses for driving?

www.mnz.co.nz
 TERMS & CONDITIONS
I agree and acknowledge as follows:

a. I will be bound by the rules of MNZ as contained in the MNZ Manual of Motorcycle Sport, the Constitution of MNZ and the Code of Conduct and any amendments
which may be made from time to time (“the Rules”).
b. I acknowledge that the Rules are posted to MNZ’s website www.mnz.co.nz (“the website”) and that the posting of the Rules on the website that shall be deemed to
be adequate notice to me of the Rules.
c. I acknowledge that the notice of the MNZ AGM, with Minutes of the previous AGM and Audited Financial Accounts to balance date can be emailed to me at my
email address provided.
d. I authorize any hospital or medical practitioner to furnish information regarding my medical condition to MNZ.
e. I consent to the collection of personal information by MNZ for the purposes of a membership record and for MNZ to retain and disclose these to affiliated clubs
and registered private promoters.
f. I acknowledge my right to access and correct any personal information held by MNZ.
g. I acknowledge that motorcycling is sport which involves some risk to my person and/or property and I agree that I participate in any event, race or meeting for
which MNZ has issued a permit or is in anyway associated (“Event”) at my own risk and I agree that in the event of injury to myself or my property including in the
event of my death neither I nor my estate will bring any claim, proceeding or otherwise seek compensation in any form:
I. MNZ, its servants, agents or employees; or
II. Competitors in any Event in which I participate; or
III. The owner, lessee or person entitled to possession of any land or place; or
IV. Any other persons or bodies associated with the Event and I indemnify all such parties against all actions, claims, demands and costs brought by any
third party arising from and out of my participating in an Event or my presence on any land or place on which and Event is held, or to be held, and I
agree that this indemnity shall endure during such period as I am the holder of a competition licence issued to me by MNZ and shall be binding on my
assigns, executors and administrators.
h. I certify that the above information is true and accurate and I understand my licence may be revoked if any information provided by me is incorrect.

General Terms and Conditions of Trade for Services

1. Services
1.1 The Services shall be as described on any invoices, quotation, work authorisation, or any other forms which are provided by the Seller to the Buyer.
1.2 “Incidental Items” means any goods, documents, designs, drawings or materials supplied, consumed, created or deposited incidentally by the Seller in the
course of it conducting, or supplying to the Buyer, any Services.

2 Price And Payment

2.1 The Price shall be as indicated on the Seller’s licence form which is provided by the Seller to the Buyer in respect of the Services supplied.
2.2 Time for payment for the Services shall be of the essence and will be stated on the invoice, quotation or any other order forms. If no time is stated then
payment shall be due on delivery of the Services.
2.3 The Price shall be increased by the amount of any GST and other taxes and duties, which may be applicable, except to the extent that such taxes are expressly
included in any quotation given by the Seller.

3. Default & Consequences Of Default

3.1 Interest on overdue invoices shall accrue daily from the date when payment becomes due, until the date of payment, at a rate of two and a half percent (2.5%)
per calendar month (and at the Seller’s sole discretion such interest shall compound monthly at such a rate) after as well as before any judgment.
3.2 If the Buyer owes the Seller any money the Buyer shall indemnify the Seller from and against all costs and disbursements incurred by the Seller in recovering
the debt (including but not limited to internal administration fees, legal costs on a solicitor and own client basis, the Seller’s collection agency costs, and bank
dishonour fees).

4. Title
4.1 The Seller and the Buyer agree that where it is intended that the ownership of Incidental Items is to pass to the Buyer that such ownership shall not pass until
the Buyer has paid the Seller all amounts owing for the Services.

5. Cancellation
5.1 In the event that the Buyer cancels delivery of the Services the Buyer shall be liable for any and all loss incurred (whether direct or indirect) by the Seller as a
direct result of the cancellation (including, but not limited to, any loss of profits).

6. Privacy Act 1993

6.1 The Buyer authorises the Seller or the Seller’s agent to:
(a)access, collect, retain and use any information about the Buyer;
(i) (including any overdue fines balance information held by the Ministry of Justice) for the purpose of assessing the Buyer’s creditworthiness; or
(ii)for the purpose of marketing products and services to the Buyer.
(b)disclose information about the Buyer, whether collected by the Seller from the Buyer directly or obtained by the Seller from any other source, to any
other credit provider or any credit reporting agency for the purposes of providing or obtaining a credit reference, debt collection or notifying a default
by the Buyer.
6.2 Where the Buyer is an individual the authorities under clause 6.1 are authorities or consents for the purposes of the Privacy Act 1993.
6.3 The Buyer shall have the right to request the Seller for a copy of the information about the Buyer retained by the Seller and the right to request the Seller to
correct any incorrect information about the Buyer held by the Seller.

I agree to be bound by these terms and conditions

Signed Date

Parent/Guardian Consent Form

I, am the parent/guardian of
who Is under 18 years of age, and hereby provide my consent to the granting of their application for a Motorcycling New Zealand licence.

Signed Date

www.mnz.co.nz
 ROAD RACE NUMBER SCHEME
Name

Licence No.

Address

Phone

Email

1st Choice 2nd Choice 3rd Choice

Superbike
Supersport 600
Supersport 300
Supersport 150
Superlite
250 Production
Sidecars
GIXXER 150
GP 125 / 250 Mono
650cc Pro Twin

Position(s) gained in 2021 NZ Road Race Championship:

I declare that I will compete in more than six road race meetings
throughout New Zealand in the 2022-2023 season.
Signature

PAYMENTS Numbers are no charge - payment required for courier delivery, if required, only

Free delivery (NZ Post) COURIER Urban $10 Rural $14

Direct Bank Credit Account: Cash
ANZ, Huntly
Motorcycling New Zealand Inc. 06–0329–0008518–00
(Please add your MNZ Licence Number in Reference)
Credit Card
Card No: Credit card transaction fee will apply 3% per transaction
- - -

Card Account Name:

Expiry Date: Amount: $

03-10-2022

Signed: Date:
2022-2023

www.mnz.co.nz

www.mnz.co.nz