Dirt Karting Entry Form

ZONE 7 DIRT KARTING CLUB CHAMPIONSHIP ROUND 4

3 October 2020


Info: Vicki Laubscher (Race secretary)
Cellphone: 084 296 6873
Email: admin@zone7.co.za

Chairman:
Jaco Strydom
Cellphone: 083 634-2469
Email: jaco@backsberg.co.za

Vice-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 Development270cc390cc Standard Ladies390cc Standard390cc Mod300ccSupermodsWing KartsBeetles 680ccJunior Wing Kart300c Wing KartB-Class Wing
I have competed in more than 3 events *
YesNo

MEDICAL & EMERGENCY

Medical Cover
YesNo
Name of Emergency Contact *

Emergency Contact Number *

CLUB MEMBERSHIP
Club Membership 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 300.00 – Members
                   R 250.00 – 2nd Family Member
                   R 300.00 – NON Members
Zone 7 Dirt Karting
Capitec Bank
Branch Code: 47 00 10
Acc #: 1344612960
Reference: Name and Surname

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

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