Capital Blokart® Club

Waitarere Beach 100k Marathon 2010

REGISTRATION FORM

^{all fields
marked *
are
compulsory}

surname: ^*

first name: ^*

weight category: ^*

race length: ^*

the entry fee of $5 along with relevant membership fee for non CBC members is to be paid on the day

entry fee: ^*CBC membership #: wn

are you a member of another blokart club? (if so please specify):

blokart chassis number:

blokart sail number (if applicable):

I don't have sail numbers: blokart sail colour:

fill in the following details if you are not a paid up Capital Blokart Club member or your details have changed

address:

home phone:

work phone:

cell phone:

email address:

number of months sailing:

Remember to include cell phone number to get last minute updates

RELEASE AND INDEMNITY

1. I will abide by the rules of Capital Blokart Club Inc displayed on site or any instructions either written or verbal from the members or organisers of Capital Blokart Club Inc.

2. Should I cause any injury or damage to myself/my associates, any other patrons, to any members of the public or to any property, waiver any form of liability to the Members of Capital Blokart Club Inc. against all actions, claims or expenses in respect of any such injury or damage.

3. Capital Blokart Club Inc. have the absolute right to refuse any person.

4. I am aware that I am entering this event at my own risk.

5. I agree for Capital Blokart Club Inc. to retain the following information for marketing purposes.

I have read and understood the rules and disclaimer. I intend to have an awesome time and will be a good sport!