Organised Practice Request — Rockhampton Kart Club

By completing and submitting this online form, I/We agree to abide by the Rules, Guidelines and Signage of the Rockhampton Kart Club Inc.

Date of Practice:

YYYY

Karter Name:

First Name

Last Name

Karter Phone Number:

Address of Karter:

Karter Email:

Licence Type:

RKC

MKC

Other

Licence Number / Details:

Practice Group:

Legal Guardian (if under 18 years of age)

Name of Associate (if the Karter under 18 years):

First Name

Last Name

Associate Phone Number:

(###)

###

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