F4 ENDURO Race Entry Form
SUBARU F4 ENDURANCE CHALLENGE ENTRY FORM
EVENT DATE CLASS: ( circle ) HEAVY / LIGHT
|
TEAM NAME |
KART NO |
NO OF DRIVERS |
ENTRY FEE |
|
4hr - $200.00 |
TERMS & CONDITIONS OF ENTRY
I/we, the undersigned acknowledgethat this meeting is conducted in accordance with Picton Karting Track and the supplementary regulations issued for this meeting and agree to abide them. I/we certify that the particulars supplied on this entry form are true and correct in every particular. I/we also understand and accept submission of this entry form constitutes an agreement with the organisers to take part in this event. I/we acknowledge that any structural, mechanical, repairs, and/or modifications to the kart is the sole responsibility of the listed signed team member/s, and that no liability is accepted by Picton Karting Track and its officials.
|
DRIVER 1 NAME |
DRIVER ID |
PKT LIC NUMBER |
EXPIRY DATE |
SIGNATURE |
WEIGHT (Heavies) |
|
DRIVER 2 NAME |
DRIVER ID |
PKT LIC NUMBER |
EXPIRY DATE |
SIGNATURE |
WEIGHT (Heavies) |
|
DRIVER 3 NAME |
DRIVER ID |
PKT LIC NUMBER |
EXPIRY DATE |
SIGNATURE |
WEIGHT (Heavies) |
|
DRIVER 4 NAME |
DRIVER ID |
PKT LIC NUMBER |
EXPIRY DATE |
SIGNATURE |
WEIGHT (Heavies) |
Purchases: …………………………………….
Entry Fee $..................
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Purchases $..................
……………………………………………………
TOTAL: $..................
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NAME OF PERSON CHECKED LICENSES EXPIRY DATE ENTRY FORM CHECKED OFFICAL SIGNATURE ACCEPTING ENTRY Paid in full YES NO