Entry Form - Single - Natal Off Road Motor Club

Single-Seater Entry Form

ENTRY FEE

R2000.00 – A – B – FIA
R800.00 – Clubmans
R200.00 – Social Class

Competitors wishing to enter must deposit their money directly into the bank account detailed and proof of payment should be emailed to normc@sai.co.za. Competitors’ name and competition (not licence) number must appear on the proof of payment to ensure that monies are credited to the correct entry.

BANKING DETAILS

ACCOUNT NAME: NATAL OFF ROAD MOTOR CLUB
BANK: ABSA
ACCOUNT NUMBER: 1140171588
BRANCH: CHATTERTON ROAD, SANCTUARY, PIETERMARITZBURG
BRANCH CODE: 632005

CLASS & CAR SECTION

Competition #

Class Entering

Vehicle Make

Vehicle Model

Vehicle CC

What type & model GPS do you use?

DRIVER SECTION

First Name

Last Name

MSA Lic #

NORMC Membership #

ID #

Blood Group

Allegies / Medical Conditions

Phone

Street Address

City

Province

Emergency Contact Name

Emergency Contact Phone

How many people are coming with you?

SIGNATURE

TERMS AND CONDITIONS

I, undertake to ensure that all necessary and reasonable steps, in all aspects of safety, are applied when setting up our pit and for the duration of the event. I have read and understand GCR's 93,94, 113, 121 & 122 of the M.S.A. Handbook and signify our agreement to abide by these rules by signing this entry form.