Nominations JKC – Adelaide Dirt Kart Club

Event and Contact Information

Junior Kart Championships

Contact Email Address*

Contact Phone Number*

Driver 1

Drivers Name*

First Last

Licence Number

Member Club

Driver 1 Class

Nomination Type

Driver 1 Preferred Kart Number

Would you like to nominate a second driver ?

Yes
No

Driver 2

Drivers 2 Name

First Last

Licence Number

Member Club

Driver 2 Class

Nomination Type

Driver 2 Preferred Kart Number

Would you like to nominate a third driver ?

Yes
No

Driver 3

Drivers 3 Name

First Last

Licence Number

Member Club

Driver 3 Class

Nomination Type

Driver 3 Preferred Kart Number

Would you like to nominate a fourth driver ?

Yes
No

Driver 4

Drivers 4 Name

First Last

Licence Number

Member Club

Driver 4 Class

Nomination Type

Driver 4 Preferred Kart Number

Pre Order JKC Hoodie

JKC Hoodie - 1st

Youth Medium
Youth Large
Adult Small
Adult Medium

JKC Hoodie - 2nd

Youth Medium
Youth Large
Adult Small
Adult Medium

JKC Hoodie - 3rd

Youth Medium
Youth Large
Adult Small
Adult Medium

JKC Hoodie - 4th

Youth Medium
Youth Large
Adult Small
Adult Medium

Complete and Pay

Declaration*

I/We agree to abide by the Rules and Regulations of the "JKC" + Host Clubs, and shall not bring any action, claim or demand whatsoever as a result of any personal injury or damage to property caused by or arising out of the use of a Go-Kart against the Promoters, the owners of the land, the Clubs, its duly elected committee or any club member. I/We agree to encourage and promote the sport of Go-Karting and ensure to exhibit the spirit of sportsmanship and good fellowship at all times when using the track or club facilities. Payment of the nomination fee is a commitment to undertake the series, therefore no refunds will be offered if any of the rounds can not be attended. As a member you agree to the usage of your name and photos for use in social media.

I Agree

Total

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