The entry form is now available. If you require a copy to be emailed,let me know and I'll send it to you.
2010 Australian
Blokart Open
Entry form
(print…complete…and post/email asap)
Organising Body : The Central Queensland Blokart Club in conjunction with Australian Blokart Association
The Australian Blokart Open runs from the 26th to the 28th of March 2010 and is to be held on Farnborough beach at Capricorn Resort, Yeppoon, Queensland.
National and International competitors will compete in Production and/or Performance categories in their weight divisions for the champion’s title.
Name: (first)_______________________ (last)_____________________________
Gender (select): Male / Female
Postal Address: ______________________________________________
Country: __________________________
Land Phone:____________________ Cell Phone:____________________
Email (mandatory):
Club:_______________________________________________________
Race Number (chassis number or can be supplied):__________________
Division:___________________________
(Lightweight under 65kg, Middleweight 65-80kg, Heavyweight 80-95kg and Supers 95+kg)
Weight categories may be changed at the discretion of the organizers depending on entry numbers
Category:_ Production or Performance _________________________
Note: Competitors may only enter one weight division. IBRA rules apply.
Competitors may enter both categories, performance and production, with eligible karts, two entry fees and two transponders required.
Entry Fee
Competition entry fee also includes buffer dinner for one person on Saturday evening, electronic timing, race insurance & Great Aussie hospitality. Additional meal tickets for partners & kids may be purchased.
Entry Fee received before Feb 15th AU$90 (an early registration discount of AU$20 included)
Entry Fee received Feb 15th or after AU$110 Amount Payable AU$_________
Transponder Hire @ $20.00 each if you do not have a compatible one
Amount Payable AU$_________ Catering for Saturday Evening Dinner: Please include me in the complimentary Meal (select): Yes / No
I wish to include (number) ____ extra person/s in the meal at $51pp.
I wish to include (number) ____ extra kids in the meal at $15.00each (4-12 years)
Amount Payable AU$_________
Total Amount Payable AU$_________
Payment Details
Cheque or Bank Transfer (circle) International visitors can pay at registration
Cheque: make out to CENTRAL Qld Blokart Club Inc and
Post to: David Moore 429 Marian-Hampden Road, Marian, Qld 4753, Aust
Contact Phone/fax: 07 49543465 Contact e-mail:
[email protected]Bank Transfer
Account Name: Central Qld Blokart Club Inc Bank: 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 Association and 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.
Signed:________________________________ Date: / /2010
If you would rather not receive info on our sponsors very cool products please tick this box
E-mailed entries are to be signed by the participant (or Legal Parent/Caregiver) at registration.
Privacy: The information given on this form is for the use of the organisers and sponsors only. This information is collected for administration and marketing purposes and is held by Central Queensland Blokart Club Inc, 429 Marian-Hampden Rd, Marian, Queensland 4753, Australia.
Confirmation and any further details will be sent to you via email.
Additional Information
Accommodation Options (all reservations to be made direct)
The Resort offers different levels of accommodation
Reservations
Aus: Ph 1800 075 902 please mention this event to achieve the blokart room discount.
NZ: Ph 0800 446 187 request to be transferred to Yeppoon
International: Ph (+61 7) 4925 2525
Some of the 25 FREE activities to enjoy during your holiday include:
Tennis, Swimming pools, table-tennis, lawn bowls, 9 hole mini golf, volleyball, catamarans, surf skis, spa, sauna, walking tracks, bike hire, archery and much much more.
