Twilight Series
 
REGISTRATION FORM

Dec 2009 2nd & 16th,   Jan 2010 6th & 20th,   Feb 2010 3rd & 17th

all fields marked * are compulsory

first name:    * surname:    *


weight category:   *
 
the entry fee of $5 per day along with relevant membership fee for non CBC or MBC members is to be paid on the day, or pay for the series up front and save!

 entry fee:  * CBC membership #:  wn
 
are you a member of another blokart club? (if so please specify): 
blokart chassis number:                   blokart sail colour:             

 sail number:         I don't have sail numbers:

 Make sure you include a cell number below if you want timely text updates about the twilight weather conditions

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:

 
   
 
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!

 *