CHRISTCHURCH GRASS TRACK KART CLUB

MEMBERSHIP DETAILS 2007/8

FOR NEW MEMBERS / ANNUAL RENEWAL

 

(Clear Block Letters Please)

 

Family $40 / Individual $30  (circle one)

 

 

NAME  …………………………………………………………………………………

 

AGE AS AT 1^ST NOV (M, I, J,  GRADES ONLY)…………………………………

 

POSTAL ADDRESS …………………………………………………………………

 

…………………………………………………………………………………………..

 

EMAIL ADDRESS ……………………………………………………………………

 

HOME Ph   ………………………            MOBILE Ph…………………………….

 

KART NUMBER   ………………….

 

INTENDED RACING GRADE  (if known)   …………………………

 

DUTY TEAM NUMBER   (if known)  ………………………………..

 

OTHER FAMILY MEMBERS NAMES AND KART NUMBERS  (if applicable)

                                                                                   (Age M I J Grades only)

     

Name …………………………………… Kart No………Age……Grade………………..

 

Name …………………………………… Kart No………Age……Grade………………..

 

Name …………………………………… Kart No………Age……Grade………………..

 

Name …………………………………… Kart No………Age……Grade………………..

 

Name …………………………………… Kart No……….Age…...Grade………………..

 

I/We have read and understand the rules and regulations put forward by the Christchurch Grass Track Kart Club and will abide by those rules and keep our kart(s) up to the specifications stated in those rules.

 

 

SIGNED   ………………………………….              DATE  ……………………….