Nominations – Adelaide Dirt Kart Club

Event and Contact Information

Event Date

Contact Email Address*

Contact Phone Number*

Driver 1

Drivers Name*

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1*

Class 1 Preferred Kart Number

Class 1 Transponders Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Would you like to nominate a second driver ?

Yes
No

Driver 2

Drivers 2 Name

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1

Class 1 Preferred Kart Number

Class 1 Transponder Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Would you like to nominate a third driver ?

Yes
No

Driver 3

Drivers 3 Name

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1

Class 1 Preferred Kart Number

Class 1 Transponder Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Would you like to nominate a fourth driver ?

Yes
No

Driver 4

Drivers 4 Name

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1

Class 1 Preferred Kart Number

Class 1 Transponder Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Would you like to nominate a fifth driver ?

Yes
No

Driver 5

Drivers 5 Name

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1

Class 1 Preferred Kart Number

Class 1 Transponder Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Would you like to nominate a sixth driver ?

Yes
No

Driver 6

Drivers 6 Name

First Last

Licence Number

Member Club

Nomination Type

Number of classes nominating

Class 1

Class 1 Preferred Kart Number

Class 1 Transponder Number

Class 2

Class 2 Preferred Kart Number

Class 2 Transponder Number

Class 3

Class 3 Preferred Kart Number

Class 3 Transponder Number

Class 4

Class 4 Preferred Kart Number

Class 4 Transponder Number

Declarations

Declaration*

I/We agree to abide by the Constitution and Rules of the "ADELAIDE DIRT KART CLUB INC" 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 owners of the land, the Club, 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. As a member you agree to the usage of your name and photos for use in social media.

I agree

Total

$ 0.00

Refund Policy

ADKC has implemented the following refund policy for those paying their nominations via paypal. A nomination can be cancelled anytime up to 12pm on the Saturday of the event for full refund. All cancellations must be done via email to nominations@adkc.com.au and the refund will be returned to the original payment method as soon as possible. Any cancelled meeting will also be refunded via the same method.