Loxton Kart Club Membership

2024 Loxton Kart Club Membership
FAMILY MEMBERSHIP ($80.00)
2 Adults & dependants

SINGLE MEMBERSHIP ($50.00)
Persons over 17 years of age
Membership Type*
How Many Family Members*
Member Details
Name (Adult)*

First NameLast Name
Birth Date*

DayMonthYear
Name (Adult)*

First NameLast Name
Birth Date*

DayMonthYear
Name (Dependent)*

First NameLast Name
Birth Date*

DayMonthYear
Name (Dependent)*

First NameLast Name
Birth Date*

DayMonthYear
Name (Dependent)*

First NameLast Name
Birth Date*

DayMonthYear
Name (Dependent)*

First NameLast Name
Birth Date*

DayMonthYear
Residential Address*

Street Address

Suburb

CityState / Territory

Post Code
Email*
example@example.com
Mobile Phone Number*
Please enter a valid mobile phone number.
Emergency Contact*

First NameLast Name
Emergency Contact Mobile Phone Number*
Please enter a valid mobile phone number.
Agreements

Code of Conduct Policy is available from Loxton Kart Club Membership web site.

If you have any questions please email Julie Falland (Club Licence Secretary) falland@riverland.net.au.

By submitting this membership form I acknowledge that I/we agree to the following.

Major Working Bees

I will attend a minimum of two major working bees.

Code of conduct

The Club Code of Conduct Policy must be abided by at all times.

I have read, understand and agree to abide by the Policy. As guardian of any registrants under 18 years (and anyone else I'm registering), I have discussed the Policy and ensured they understand and agree to abide by it.

Ambulance Cover

I agree and confirm that I/we hold adequate ambulance cover and indemnify the Club of any ambulance or transport costs.

Use of digital media

As member and guardian of the members listed on this registration form, do you consent that any club affliated with AIDKA may use any photograph taken in a positive manner for the good of sport.
Media Consent*
We will assist with the following duties. (select as many as you feel comfortable)

Pre-race day Saturday preparation (cleaning out clubrooms/toilets/scrutineering shed,ploughing up the sand traps)Track Preparation (watering leading up to an event)Race day set up/pack up (race lights, bins, fire extinguishers, PA speakers, cones etc.)Stewarding (Licence Accreditation Required)Scrutineering (Licence Accreditation Required)Starter (Licence Accreditation Required)Grid MarshallLight BoxLap ScoringCanteen
Preference will be given to out of town members for the jobs that can be done on race days. Information received from this form will assist us to make a roster of jobs throughout the year
Would you like your AIDKA Log Books mailed to your postal address (additional $3.00 fee)? You can collect at the track if you intend on racing at Loxton Kart Club for your first race meeting. Please contact Julie Falland if you wish to collect prior to first LKC meeting*
Postal Address for Log Books (only required if different to the Residential Address)
Total Cost

Online Payment

AUD

Credit Card

Should be Empty:

2024 Loxton Kart Club Membership

Credit Card