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first name:
surname:
email:
address:
city:
home phone:
cell phone :
(useful for
txt updates)
weight:
kg
race category:
club:
transponder no:
(or
"hire")
race classes will be determined by entry numbers
race entry fee: $70 + $15 Transponder
hire? add $20 if not current NZBAI member
Late fees additional $20 if paid
after 7th November
Overnight kart storage will be available at $5 per night, please
include with your fees if you require
Please indicate if you want to attend Thursday practice day:
($10 track fee charged on the day)
Get
together on Thursday and Friday after racing is organised at
Jessie's Bar, Wigram. Bar meal available -
To help with their catering, please advise number requiring
a meal:
Dinner and social event on Saturday is booked at Hornby Working Mens
Club
book for dinner on Saturday
$29 ea - prepay with race entry fee
Please pay by direct bank deposit into our
Westpac
Bank
a/c
number 03-1707-0124984-00
(ensure you include your name, otherwise, thank
you for your donation!), or by a cheque made out to Canterbury
blokart Club Inc and post to
:
Barry Emms 7a Barnes Rd. Redwood Christchurch 8051
(make sure chq
arrives by 7 Nov to avoid paying $20 late fee)
Pick up from Airport? Flight No. , time and number of people:
Release and Indemnity
-
I/we agree to comply with the rules and
by-laws of New Zealand blokart Association Inc.
-
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.
-
NZBAI. have the absolute right to refuse any
person.
-
I am aware that I am entering this event at my
own risk.
-
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!
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