Winton Historic Titles Historic Winton 2022 Rider's Name * First Name Rider's Name * Last Name Date of Birth * Email Address Phone Number * Current Ambulance Membership * Yes No Address * Suburb * Postcode * Club * MA Licence Number * MA Licence Expiry Date * Next of Kin * Next of Kin Contact Number * Are you a Life Member of HMRAV? Yes Sidecar Entry (Non Life Member) Yes Sidecar Entry (Life Member) Yes Sidecar Passenger Details Passenger's Name * Date of Birth * Phone Number * Address * Suburb * Postcode * MA Licence Number * MA Licence Expiry Date * Next of Kin * Next of Kin Contact Number * Current Ambulance Membership * Yes No Club Entrant / Sponsor MA Licence Number MA Licence Expiry Date How Many Bikes Are You Entering * 1 Bike 2 Bikes 3 Bikes 4 Bikes BIKE DETAILS DON'T FORGET TO BRING YOUR LOG BOOKS TO THE TRACK Class * Each machine can be entered into up to 2 classes Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar LOG BOOK NUMBER * Preferred Race Number Make * Model * Capacity * Year * Enter Machine into 2nd Class? Yes (adds $0 to entry fee) 2nd Class * Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar BIKE No.1 DETAILS DON'T FORGET TO BRING YOUR LOG BOOKS TO THE TRACK LOG BOOK NUMBER * Preferred Race Number Make * Model * Capacity * Year * Class * Each machine can be entered into up to 2 classes Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar Enter Machine into 2nd Class? Yes (adds $0 to entry fee) 2nd Class * Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar BIKE No.2 DETAILS DON'T FORGET TO BRING YOUR LOG BOOKS TO THE TRACK LOG BOOK NUMBER * Preferred Race Number Make * Model * Capacity * Year * Class * Each machine can be entered into up to 2 classes Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar Enter Machine into 2nd Class? Yes (adds $0 to entry fee) 2nd Class * Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar BIKE No.3 DETAILS DON'T FORGET TO BRING YOUR LOG BOOKS TO THE TRACK LOG BOOK NUMBER * Preferred Race Number Make * Model * Capacity * Year * Class * Each machine can be entered into up to 2 classes Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar Enter Machine into 2nd Class? Yes (adds $0 to entry fee) 2nd Class * Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar BIKE No.4 DETAILS DON'T FORGET TO BRING YOUR LOG BOOKS TO THE TRACK LOG BOOK NUMBER * Preferred Race Number Make * Model * Capacity * Year * Class * Each machine can be entered into up to 2 classes Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar Enter Machine into 2nd Class? Yes (adds $0 to entry fee) 2nd Class * Vintage Hand shift Battle Class c P3 125 P3 250 P3 350 P3 500 P3 Unlimited P4 125 P4 250 P4 350 P4 500 P4 Unlimited P5 125 P5 250 P5 350 P5 500 P5 600 P5 Unlimited P3 Sidecar 650 P3 Sidecar Unlimited P4 Sidecar 836 P5 sidecar I have acknowledged and agree to abide by the Suplementary Regulations. * Yes View Suplementary Regulations here Life Member Status - you only pay Entry Fee Total ($AUD) Securely PAY by Credit Card * If you are human, leave this field blank.
