2012Australian
Blokart Open
Entry Form
Organising Body: Central Queensland Blokart Club
The 2012 Australian blokart Open runs from the 16th to the 19th of March 2012 and is to be held on FarnboroughBeach at Mercure Capricorn Resort, Yeppoon, Queensland.
National and International competitors will compete in Production or Performance categories in their weight divisions for the champion’s title in short course races and a separately scored 100km marathon.
Friday:Practice/Registration, Saturday- Sunday short course racing, Monday 100km marathon.
Complete electronically and email to or copy, fill in and post/ fax asap)
Name: (first) (last)
Gender(select): Male / Female
Postal Address:
Country:
Land Phone: Mobile Phone: 04
Email (mandatory):
Club:
Race Number (preferred number (must be in early) or can be supplied):
Estimated race weight kg
Weight categories may be changed at the discretion of the organizers depending on entry numbers.
Racers will be weighed at the event and weight divisions will be allocated by the race committee.
Category: _ Performance/Production
Note:IBRAand CQBC rules apply.
Production and Performance karts will race together and be scored separately to allow the maximum number of races.
Entry Fee
Competition entry fee also includes buffet dinner for one person on Saturday evening, electronic timing, race insuranceGreatAussie hospitality.Additional meal tickets for partners & kids may be purchased.
Entry Feepaid before15thFebruary ABA club member $95
Non-ABA member $115
Entry Fee paid after 15th February ABAclub member $125
Non-ABA member $145
Includes one meal Racer Entry Fee AU$
Transponder Hire @ $20.00each if you do not have a compatible AMB/Mylaps one.
Transponders may be purchased for $160 each. Transponder Purchase AU$
Or Transponder Hire AU$
Catering for Saturday Evening Dinnerat Capricorn Resort:
Racer entry fee includes one complimentary meal on Saturday night.
I wish to include (number) extra person/s in the meal at $50 pp.
I wish to include (number) extra kids in the meal at $15.00each (4-12 years)
Extra Meals AU$
Total Amount Payable AU$
Payment Details
Cheque or Bank Transfer (circle) International visitors can pay at registration
Cheque: make out toCentral Qld Blokart Club Incand
Post to:Darren Bianchi, 9 Warland Street Mackay 4740 Qld Australia
Contact Phone: 0749521889 Contact e-mail:
Mobile: 0458775595 Fax: 07 49526095
Bank Transfer
Account Name:Central Qld Blokart Club IncBank: Wide Bay Aust Ltd
B.S.B No: 656400 A/C Reference# 105200689
Please ensure to put your full name on the transfer.
Release and Indemnity
Australian Blokart Association in Conjunction with The Central Queensland Blokart Club will take all reasonable steps to safeguard every competitor in the Australian blokart Open.
In consideration for your permitting registration of this child(ren) or yourself to participate in the following blokart sailing activities, the participant(s) does hereby release Australian Blokart Associationand The Central Queensland Blokart Club and all affiliated and associated organisations, together with their representatives, members or agents, of and from any and all demands of any kind or nature whatsoever, arising out of or in any way related to any participation in such activities, including any personal injury or death which may be suffered or incurred as a result of participation in such activities whether or not caused by the negligence or wrongful acts of such persons or any agents or members of the Australian Blokart Association or the Central Queensland Blokart Club, I further agree to indemnify and hold harmless each of them of and from any and all claim, demands or action of any kind or nature whatsoever arising out of any injury or damages incurred by the registered participant. No refunds in the event of cancellation.
Signed:______Date: / /2012
E-mailed entries are to be signed by the participant (or Legal Parent/Caregiver) at registration.
Payment of entry feeconstitutes agreement of conditions.
Privacy: The information given on this form is for the use of the organisers and sponsors only. This information is collected for administration purposes and is held by Central Queensland Blokart Club Inc, 9 Warland Street, Mackay, Queensland 4740, Australia.
Confirmation and any further details will be sent to you via email.
Club Sponsors