Kentucky Dirt Karting Association
Application for Membership
Application for Membership
Please print all information clearly. Master members must be at least 18 years of age. Those under 18 years of age must join as an Associate member with their parent or guardian as a Master member. Original birth certificate must be presented at registration of the first event attended for participants in all Junior classes.
Master Member Information
Name: _____________________________________ Age: ________
Address: ___________________________________ Birth Date: _________________
___________________________________ Sex: M F
Phone: H (______)_______________________C (______)_______________________
E-mail: ___________________________________________________________
Classes: ____________________________________Kart #: ________________
Signature: __________________________________ Date __________________
___________________________________ Sex: M F
Phone: H (______)_______________________C (______)_______________________
E-
Signature: __________________________________ Date __________________
Associate Member Information
Name: ______________________________________Age: _______ Sex: M F
Relationship to Master Member: ___________________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Name: ______________________________________Age: _______ Sex: M F
Relationship to Master Member: ___________________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Name: ______________________________________Age: _______ Sex: M F
Relationship to Master Member: ___________________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Birth Date: ______________Classes: _________________________Kart # _________
Signature: __________________________________
Fees
Racing Master Member $ 10.00
Non-Racing Master Member N/C
_____ Associate Members @ $10.00 each $ _________
Check # ________ for total $ _________
Please make Checks payable to Kentucky Dirt Karting Association (KDKA) P.O. Box 1495, Richmond, KY 40476-1495 - Webb Site: kdkaracing.com
Check # ________ for total $ _________
Please make Checks payable to Kentucky Dirt Karting Association (KDKA) P.O. Box 1495, Richmond, KY 40476-
