2009 U.S. 13 Kart Club Track Membership

Located 1 mile North of MD-DE State Line

on Sussex Hwy (Rt. 13), Delmar, DE

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     x ____=____________

Total owed ____________________ Paid      Check #________   Cash _________

Signature____________________________________________________