F4 Sprint Race Entry Form
ENTRY FORM
SUBARU F4 SPRINT RACING
EVENT DATE CLASS: HEAVY / LIGHT
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DRIVER NAME |
KART NO |
TRANSPONDER NO |
PKT Lic No. |
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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 driver whose signature appears below. and that no liability is accepted by Picton Karting Track and its officials.
Signature of Driver: …………………………………….......... Date ………………........
Signature of Parent/Guardian: …………………........... Date ………………………
(for drivers under 18 years old)
Name of Parent/Guardian : …………………………………………………………………………….
PAYMENT OPTIONS: Pay be Eftpos, cash or cheque at Picton Karting Track Office.
BY MAIL: Pay be cheque, money order or credit card (please fill out credit card details below and send to Picton Karting Track, 200 Picton Rd, Picton NSW 2571
BY EMAIL: Email Entry Form with credit card details to info@pkt.net.au
Entry Fee $75.00
Credit Card Details:
CREDIT CARD NO: ……………………………….EXPIRY:…… /……
NAME ON CARD: ……………………………SIGNATURE: ……………………..
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NAME OF PERSON CHECKED LICENSES EXPIRY DATE |
ENTRY FORM CHECKED OFFICAL SIGNATURE ACCEPTING ENTRY |
Paid in full YES NO |