PERMIT APPLICATION For Competition Events APPLICATION FOR (please tick relevant boxes): National (Open) Junior Road Race Dirt Track Region (MX Only) Motocross Historic Road Race Hare Scramble Interclub Club Supercross Enduro Trials Speedway Hill Climb Classic Motocross Will this event host a Womens/Girls class? Yes No Club/Promoter: Address: Suburb: State: Postcode: Telephone B/H: A/H: Fax: Name of person making application: Date: / / Meeting name: Venue: Date/s of meeting: Proposed spectator entry fee: Adult: $ Child $ Other $ Please advise us of your First Aid Provider*: HAVE YOU INCLUDED THE FOLLOWING? (please tick) Have you provided names and / or copies of First Aid Certificates of your club s First Aid Officers? Has the date been approved by the relevant Management Committee? (For Interclub & Open events) Have you emailed a draft copy of the Supplementary Regulations for approval? (Required for all Club, Interclub & Open events) Have you nominated an event Steward? (Club & Interclub events) Have you completed the separate Steward nomination form? (Open events) Payment of all fees? Have you completed all sections and signed in the appropriate places? SEND COMPLETED APPLICATION TO: MOTORCYCLING VICTORIA P.O. Box 3 BROADFORD VIC 3207 FAX: 03 9673 0620 EMAIL: admin@motorcyclingvic.com.au
ACKNOWLEDGEMENT OF PERMIT CONDITIONS 1. STEWARD NOMINATION Please note that the designated Steward and only that Steward can issue, receive and control official MA Licence Declaration Forms. These declarations must be fully and correctly completed before being accepted. Name: Address: Suburb: State: PC: Phone (B/H): Mobile: Officials Licence No.: 2. NOISE REGULATIONS All machines must comply with the General Competition Rules of Motorcycling Australia. In addition: All machines must comply with the current Manual of Motorcycle Sport. Machines exceeding the decibel regulations will be black flagged immediately upon detection and must be presented to the scrutineer for inspection. Subject to the Scrutineers approval of noise reduction measures the machine may be cleared to recommence racing. A second infringement will result in immediate black flagging and exclusion from the meeting. 3. ADMISSION TICKETS / COMPETITOR PASSES DISCLAIMER Disclaimers must be printed on all tickets/passes/credentials, worded as per the GCRs. 4. MV BOARD / MANAGEMENT COMMITTEE PASSES Following issue of permit, MV Staff, Board and Management Committee passes must be recognised and the bearer granted free admission to the meeting. Please advise your officials/gatekeepers accordingly. SIGNED: NAME: POSITION: DATE: / / OFFICE USE ONLY FEES PAID: DATE RECEIVED: Permit: $ RECEIPT NO.: CHQ NO.: St John (payable to MV): $ Broadford Hire: $ MA PERMIT NO.: TRACK LICENCE NO.:
REMITTANCE ADVICE COMPETITION PERMITS COMPETITION PERMIT FEES (Permit Application form must also be submitted) Please Note: - A Gate Admission Fee can only be charged when using an Open or State Championship Event Permit. - Interclub events are a maximum of 6 Clubs (5 clubs plus 1 host club). ROAD RACE Road Race State Championship $1000 1. 2. Road Race Open $800 3. Road Race Interclub $700 4. Road Race Club $300 + $2 per rider over 75 riders 5. MOTOCROSS Motocross State Championship $800 6. Motocross Open $700 7. Motocross Region (Gippsland/Northern/Western only) $500 8. Motocross Interclub $400 9. Motocross Club Day (up to 75 riders) $165 10. Motocross Club Day (over 75 riders) $165 + $2 per rider over 75 riders 11. ENDURO Enduro State Championship $800 12. Enduro Open $500 13. Enduro Interclub $400 14. Enduro Club Day (up to 75 riders) $165 15. Enduro Club Day (over 75 riders) $165 + $2 per rider over 75 riders 16. SPEEDWAY Speedway State Championship $800 17. Speedway Junior State Championship $300 18. Speedway Open $700 19. Speedway Interclub $400 20. Speedway Club Day (up to 75 riders) $165 21. Speedway Club Day (over 75 riders) $165 + $2 per rider over 75 riders DIRT TRACK Dirt Track State Championship $600 22. 23. Dirt Track Open $500 24. Dirt Track Interclub $400 25. Dirt Track Club Day (up to 75 riders) $165 26. Dirt Track Club Day (over 75 riders) $165 + $2 per rider over 75 riders 27. TRIALS Trials State Championship $500 28. Trials Open $400 29. Trials Interclub $400 30. Trials Club Day (up to 75 riders) $165 31. Trials Club Day (over 75 riders) $165 + $2 per rider over 75 riders 32. RIDER LEVIES Competitor Public Liability Levy (as at 1 Jan 2017)* $12 per rider entry *Must be lodged with MV by the Race Secretary within 7 days of the completion of the event including a full list of participants and payment.
OTHER FEES 33. Cancellation of Competition Permit Permit Fee TOTAL AMOUNT ENCLOSED: $ * Note: All the above fees include G.S.T. PERMIT FEE CREDIT CARD PAYMENT Credit Card Type: Visa* MasterCard* *Credit Card Payments incur $5 processing fee Credit Card Number: / / / CCV Expiry Date: / Name of Cardholder: Signature: Total Amount: $
REMITTANCE ADVICE PRACTICE PERMITS FORWARD WITH ALL PAYMENTS INCLUDING FEES FOR ST JOHN TO MOTORCYCLING VICTORIA FROM: MCC Date of Event: / / PRACTICE PERMIT FEES (Permit Application form must also be submitted) ROAD RACE 1. Road Race Practice Day $115 + $2 per rider over 75 riders MOTOCROSS 2. Motocross Practice Day $115 + $2 per rider over 75 riders ENDURO 3. Enduro Practice Day $115 + $2 per rider over 75 riders SPEEDWAY 4. Speedway Practice Day $115 + $2 per rider over 75 riders DIRT TRACK 5. Dirt Track Practice Day $115 + $2 per rider over 75 riders TRIALS 6. Trials Practice Day $115 + $2 per rider over 75 riders RIDER LEVIES 7. Participant Public Liability Levy (as at 1 Jan 2013)* $5.00 per rider participating *Must be lodged with MV by the Nominated Official/Coach on the Permit Application Form within 5 days of the completion of the event, including a full list of participants, a completed non competition report form and payment. 8. BULK PERMITS Bulk Permits can be purchased in advance by Clubs and are generally used by those holding regular Practice Days. Bulk Permits in most cases offer a discounted rate over normal Practice Permit Rates. Further information on Bulk Permits can be found on the MV Website in the Clubs section. 9. FIRST AID FEES (to be paid direct to MV) Meeting requiring one (1) *See MV MEDICAL GUIDE FOR CLUBS documented for alternates $45+GST per hour 10. Meeting requiring two (2) $90+GST per hour 11. Accommodation fee for Officers (2 days or more) $95 BROADFORD HIRE FEES (valid until 31 st January 2015) 12. Road Race Circuit Hire (any day) Fee upon application 13. Road Race Pit Shed Hire (per event) Fee upon application 14. Motocross Circuit Hire $250 + $15 track hire levy per rider ($800 minimum) 15. Dirt Track / Speedway Circuit Hire $250 + $15 track hire levy per rider 16. Enduro Loop Hire $250 + $15 track hire levy per rider 17. Supercross Circuit Hire (club and private promoter) $60 per rider per day ($400 min.) 18. Trials Area Hire $15 per rider per day 19. State Complex Clean Up Bond Fee by negotiation with Manager TOTAL AMOUNT ENCLOSED: $ * Note: All the above fees include G.S.T. PERMIT FEE CREDIT CARD PAYMENT Credit Card Type: Visa* MasterCard* *Credit Card Payments incur $5 processing fee Credit Card Number: / / / Name of Cardholder: Signature: Total Amount: $ Expiry Date: /