2008 US 13 Kart Club Membership

Master members must be 18 years of age or older.  Those under 18 must be an associate member to the parent or guardian ($20.00)

Name____________________________DOB___/___/___ Age_______

Address___________________________City/State/Zip___________________________

Phone Numbers

Day_____________________Night_______________________

Associate Member

Name____________________________DOB___/___/___

Name____________________________DOB__/___/___

Classes

1^st _____________________________________________Kart #_________

2^nd_____________________________________________Kart #_________

3^rd______________________________________________Kart#_________

4^th______________________________________________Kart#_________

Master Member $20.00  x ______ = ____________

Associate Member$10.00 x _____= ____________

Reserved Kart # $5.00 per class x ____=____________

Total owed ____________________ Paid      Check #________   Cash _________

Signature____________________________________________________