Renewal Form

Club Membership Renewal (2021 / 2022)

Name *

First

Last

Email *

Date of Birth *

Gender

Street Address

Town / City

Home Phone

Cell Phone

Emergency Contact *

First

Last

Emergency Contact Number

Existing Member

Membership Type *

Full name 1 (Parent/ Guardian)

Full Name 2 (Parent/Guardian)

Full Name 3 (Child under 19 @ 1st of April)

Full name 4 (Child under 19 @ 1st of April)

Full Name 5 (Child under 19 @ 1st of April)

Annual Track Fee ($50 per kart)

Paying by Internet Banking? (15 3977 0010775 00)

Pulley Whip Number

Email

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