Dirt Karting Entry Form

ZONE 7 DIRT KARTING CLUB CHAMPIONSHIP ROUND 6

27 July 2019

MSA Permit: MSA 15993
Click Here to Download The Supplementary Regulations
Info: Janet Buys (Race secretary)
Cellphone: 083 3850227
Email: janet@zone7.co.za

Chairman:
Johann Spies
Email: johann@zone7.co.za

Fax number: 086 2733379


PERSONAL DETAILS
First Name *

Last Name *

ID Number *

Email Address *

Cellphone Number *

Address

Go Kart Number *

Class *

Newby ClassJunior 160/200cc StandardJunior 160cc ProJunior 200cc Pro270cc A270cc B390cc Standard390cc Mod300ccSupermodsWing KartsBeetles 680cc

MEDICAL & EMERGENCY

Medical Cover
MSA
Name of Emergency Contact *

Emergency Contact Number *

MSA LICENSE AND CLUB MEMBERSHIP

Medical Cover
YesNo
MSA License Number

Declaration

I signify my/our agreement to abide by the rules by submitting this entry form. I, the lawful parent/guardian of the above-mentioned competitor, do hereby grant permission for him/her to ride in the above-mentioned event. If a competitor is a minor, this form must be submitted by the appropriate parent or guardian.

Indemnity

I Acknowledge that motorsport is dangerous. By entering Zone 7 Speedspot Cape Town and using the facilities, I acknowledge the inherit dangers associated with this sport and therefor indemnify the owners, organizers and staff.

I also indemnify the owners, organizers and staff on behalf of all non-riders and minors in my care. Therefor I utilize the facility on my own risk.

Indemnity Decleration *
If 18 years old or by the parent/guardian


EFT PAYMENTs

Entry Fee: R 200.00 - Members
                   R 150.00 - 2nd Family Member
                   R 250.00 - NON Members
Zone 7 Dirt Karting
Capitec Bank
Branch Code: 47 00 10
Acc #: 1344612960
Reference: Name and Surname

Please email relevant documents to janet@zone7.co.za.

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