New Zealand Blokart Association Inc.

first name:          surname:        email: 

address:         city:  

home phone:         cell phone :  (useful for txt updates)

weight:   kg       race category:   select lightweight < 80 kg Middleweight 80 - 90 kg Heavy 90 kg + Casual (little or no race exp) non racing helper        club:   select Auckland Hamilton Bay Kaimai Manawatu Capital Canterbury      transponder no: (or "hire")

race entry fee:  $40  + $10 Transponder hire?

Please pay by direct bank deposit into our National Bank a/c  number 06-0379-0109819-00 (ensure you include your name, otherwise, thank you for your donation!), or by a cheque made out to New Zealand Blokart Association and post to NZBAI C/o blokart^® International Ltd PO Box 11320 Papamoa 3151 (make sure chq arrives by 1st June to avoid paying twice!)

Prize Giving Dinner Sunday 7:00pm Convention Centre, Palmerston North. $37 ea
book for Dinner: 

car registration:          passengers:


Release and Indemnity

1. I/we agree to comply with the rules and by-laws of New Zealand blokart Association 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 NZBAI. against all actions, claims or expenses in respect of any such injury or damage.

3. NZBAI. 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 to comply with any restrictions or instructions from NZDF.

6. I agree for NZBAI. to retain the information on this form 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!