2007  Membership Application                                     US 13 Kart Club Delmar, DE


Driver Name:_________________'Kart #:____ Class:_______________             

Master Member $20.00

____ Associate Member (Child) $10.00 Reserved Number $5.00 EACH CLASS

Master Member Information:

Master Members must be 18 years of age or older. Those under 18 must be an Associate

Member to their Parent or Legal Guardian ($20.00)

Name:_______________________________DOB:__/__/__ Age:__ Address:______

City:________________________State:____________Zip:______

Phone Numbers:

(Day)_______________________Night:


lst Class:______________ Reserved #__________ Paid: 2ndClass:______________ Reserved #___________ Paid:

Associate Member:

Associate Members are under age 18 years of age. ($10.00)

Name:_____________DOB: Name:_____________DOB:  Name:_____________DOB: 

 

Class:

Class: Class:  

Kart #                 Paid/     Age: Kart #                 Paid/     Age:

Kart #                 Paid/     Age:

PLEASE MAKE CHECKS PAYABLE TO:

US 13 KART CLUB TRACK

MAIL TO:

U. S.  13 Kart Club Track
P. O. Box 954
Georgetown, DE. 19947
 

Total Amount Paid:_________

Cash:__ Check: __Check #:___

ANY QUESTIONS PLEASE CONTACT TREASURER