LKC Memberships

Auto-responder email will be sent to this person and email address
Send-to First Name
Send-to Last Name
Send-to Email
example@example.com
SINGLE MEMBERSHIP - $60 - for individuals over 18 years of age

FAMILY MEMBERSHIP - $90 - a household of
... up to 2 adults and any dependent children still in study

Life Members
Individuals = no fee
Family membership with at least ONE life member and children in study = $45
Membership Type*

FAMILY MEMBERSHIP Section
Number of Parents/Adults*
Number of children still in study*
ONLY children still in study

Adult 1 Information
A1-First Name*
A1-Last Name*
A1-Email*
example@example.com
A1-Phone number*
10 digits
A1-Life Member?*
Select "yes" if you are a LKC life member
A1-Racing this year?*
A1-How many classes?*
for kart number allocation
A1-Class 1*
A1-Kart 1 Number*
Kart number preferred
A1-Class 2*
A1-Kart 2 Number*
Kart number preferred
A1-Class 3*
A1-Kart 3 Number*
Kart number preferred
A1-Class 4*
A1-Kart 4 Number*
Kart number preferred

Adult 2 Information
A2-First Name*
A2-Last Name*
A2-Email*
example@example.com
A2-Phone number*
10 digits
A2-Life Member?*
Select 'yes" if you are a LKC life member
A2-Racing this year?*
A2-How many classes?*
for kart number allocation
A2-Class 1*
A2-Kart 1 Number*
Kart number preferred
A2-Class 2*
A2-Kart 2 Number*
Kart number preferred
A2-Class 3*
A2-Kart 3 Number*
Kart number preferred
A2-Class 4*
A2-Kart 4 Number*
Kart number preferred

Child 1 Information
C1-First Name*
C1-Last Name*
C1-Email (OPTIONAL)
Club may send emails if filled in
C1-Phone
OPTIONAL - 10 digits
C1-Junior Member?*
18yrs old and under?
C1-Date of birth*

DayMonthYear
C1-Age*
years old
C1-I (the parent) give permission for him/her to be a member of the Lucindale Karting Club*

I agree
C1-Racing this year?*
C1-How many classes?*
for kart number allocation
C1-Class 1*
C1-Kart 1 Number*
Kart number preferred
C1-Class 2*
C1-Kart 2 Number*
Kart number preferred
C1-Class 3*
C1-Kart 3 Number*
Kart number preferred
C1-Class 4*
C1-Kart 4 Number*
Kart number preferred

Child 2 Information
C2-First Name*
C2-Last Name*
C2-Email (OPTIONAL)
Club may send emails if filled in
C2-Phone
OPTIONAL - 10 digits
C2-Junior Member?*
18yrs old and under?
C2-Date of birth*

DayMonthYear
C2-Age*
years old
C2-I (the parent) give permission for him/her to be a member of the Lucindale Karting Club*

I agree
C2-Racing this year?*
C2-How many classes?*
for kart number allocation
C2-Class 1*
C2-Kart 1 Number*
Kart number preferred
C2-Class 2*
C2-Kart 2 Number*
Kart number preferred
C2-Class 3*
C2-Kart 3 Number*
Kart number preferred
C2-Class 4*
C2-Kart 4 Number*
Kart number preferred

Child 3 Information
C3-First Name*
C3-Last Name*
C3-Email (OPTIONAL)
Club may send emails if filled in
C3-Phone
OPTIONAL - 10 digits
C3-Junior Member?*
18yrs old and under?
C3-Date of birth*

DayMonthYear
C3-Age*
years old
C3-I (the parent) give permission for him/her to be a member of the Lucindale Karting Club*

I agree
C3-Racing this year?*
C3-How many classes?*
for kart number allocation
C3-Class 1*
C3-Kart 1 Number*
Kart number preferred
C3-Class 2*
C3-Kart 2 Number*
Kart number preferred
C3-Class 3*
C3-Kart 3 Number*
Kart number preferred
C3-Class 4*
C3-Kart 4 Number*
Kart number preferred

Child 4 Information
C4-First Name*
C4-Last Name*
C4-Email (OPTIONAL)
Club may send emails if filled in
C4-Phone
OPTIONAL - 10 digits
C4-Junior Member?*
18yrs old and under?
C4-Date of birth*

DayMonthYear
C4-Age*
years old
C4-I (the parent) give permission for him/her to be a member of the Lucindale Karting Club*

I agree
C4-Racing this year?*
C4-How many classes?*
for kart number allocation
C4-Class 1*
C4-Kart 1 Number*
Kart number preferred
C4-Class 2*
C4-Kart 2 Number*
Kart number preferred
C4-Class 3*
C4-Kart 3 Number*
Kart number preferred
C4-Class 4*
C4-Kart 4 Number*
Kart number preferred

Child 5 Information
C5-First Name*
C5-Last Name*
C5-Email (OPTIONAL)
Club may send emails if filled in
C5-Phone
OPTIONAL - 10 digits
C5-Junior Member?*
18yrs old and under?
C5-Date of birth*

DayMonthYear
C5-Age*
years old
C5-I (the parent) give permission for him/her to be a member of the Lucindale Karting Club*

I agree
C5-Racing this year?*
C5-How many classes?*
for kart number allocation
C5-Class 1*
C5-Kart 1 Number*
Kart number preferred
C5-Class 2*
C5-Kart 2 Number*
Kart number preferred
C5-Class 3*
C5-Kart 3 Number*
Kart number preferred
C5-Class 4*
C5-Kart 4 Number*
Kart number preferred

Family Information Section
Emergency Contacts
Family adult(s) are automatically included.
You MAY choose to add another person to contact in an emergency.
Contact 1-First Name*
Contact 1-Last Name*
Contact 1-PHONE*
10 digits
Contact 2-First Name*
Contact 2-Last Name*
Contact 2-PHONE*
10 digits
Add another emergency contact?*
Contact 3-First Name*
Contact 3-Last Name*
Contact 3-PHONE*
10 digits
Family Residential Address
Address*
City/Town*
Post Code*
State*

Family Fee Calculation Based on Life membership status
Family Fee-1
Family Fee-2
One OR both adults are life members and have children
Family Fee-3
Both adults are life members with no children in study
Final Family Fee

SINGLE MEMBERSHIPS Section
Number of single memberships*
... that you wish to apply for

Single Member 1 Information
S1-First Name*
S1-Last Name*
S1-Email*
example@example.com
S1-Phone number*
10 digits
S1-Residential Address*
S1-City/Town*
S1-Post Code*
S1-State*
S1 Contact-First Name*
S1 Contact-Last Name*
S1 Contact-Phone*
for emergency contact - 10 digits
S1-Life Member?*
Select "yes" if you are a LKC life member
S1-Racing this year?*
S1-How many classes?*
for kart number allocation
S1-Class 1*
S1-Kart 1 Number*
Kart number preferred
S1-Class 2*
S1-Kart 2 Number*
Kart number preferred
S1-Class 3*
S1-Kart 3 Number*
Kart number preferred
S1-Class 4*
S1-Kart 4 Number*
Kart number preferred
S1-Fee

Single Member 2 Information
S2-First Name*
S2-Last Name*
S2-Email*
example@example.com
S2-Phone number*
10 digits
S2-Residential Address*
S2-City/Town*
S2-Post Code*
S2-State*
S2 Contact-First Name*
S2 Contact-Last Name*
S2 Contact-Phone*
for emergency contact - 10 digits
S2-Life Member?*
Select "yes" if you are a LKC life member
S2-Racing this year?*
S2-How many classes?*
for kart number allocation
S2-Class 1*
S2-Kart 1 Number*
Kart number preferred
S2-Class 2*
S2-Kart 2 Number*
Kart number preferred
S2-Class 3*
S2-Kart 3 Number*
Kart number preferred
S2-Class 4*
S2-Kart 4 Number*
Kart number preferred
S2-Fee

Single Member 3 Information
S3-First Name*
S3-Last Name*
S3-Email*
example@example.com
S3-Phone number*
10 digits
S3-Residential Address*
S3-City/Town*
S3-Post Code*
S3-State*
S3 Contact-First Name*
S3 Contact-Last Name*
S3 Contact-Phone*
for emergency contact - 10 digits
S3-Life Member?*
Select "yes" if you are a LKC life member
S3-Racing this year?*
S3-How many classes?*
for kart number allocation
S3-Class 1*
S3-Kart 1 Number*
Kart number preferred
S3-Class 2*
S3-Kart 2 Number*
Kart number preferred
S3-Class 3*
S3-Kart 3 Number*
Kart number preferred
S3-Class 4*
S3-Kart 4 Number*
Kart number preferred
S3-Fee

Single Member 4 Information
S4-First Name*
S4-Last Name*
S4-Email*
example@example.com
S4-Phone number*
10 digits
S4-Residential Address*
S4-City/Town*
S4-Post Code*
S4-State*
S4 Contact-First Name*
S4 Contact-Last Name*
S4 Contact-Phone*
for emergency contact - 10 digits
S4-Life Member?*
Select "yes" if you are a LKC life member
S4-Racing this year?*
S4-How many classes?*
for kart number allocation
S4-Class 1*
S4-Kart 1 Number*
Kart number preferred
S4-Class 2*
S4-Kart 2 Number*
Kart number preferred
S4-Class 3*
S4-Kart 3 Number*
Kart number preferred
S4-Class 4*
S4-Kart 4 Number*
Kart number preferred
S4-Fee

Payment Section
PAYMENT
Total Membership(s) Fee
ONLINE PAYMENTS ONLY
- A link will appear, after you submit this application, to make the payment.
- An email will be sent shortly that will ALSO have the link in it - if you choose not to pay immediately
  This may take up to 15minutes to come through
Note: until payment is received ...
- anyone included in this application, can NOT be a member of the club.
- the club will not contact AIDKA to confirm you are a club member for this year's licensing
Should be Empty: