Nomination Form

Required fields marked with an asterix.

Your Name*

Your Email*

Phone*

Club*
Dirt Trackers Kart Club Busselton Kart Club Great Southern Kart Club Jenna Kart Club Interstate Club Other

AIDKA License*

Race Class*
None Rookie 1(experienced) Rookie 2(beginners) Junior Lights Junior Heavy J Opens KT Lights KT Mediums KT Heavy KT Twin Statesmens 125 Lights 125 Heavy 100 Open 200 Open Outlaws

Race Number*

Extra Class
None Rookie Demo Junior Lights Junior Heavy J Opens KT Lights KT Mediums KT Heavy KT Twin Statesmens 125 Lights 125 Heavy 100 Open 200 Open Outlaws

Race date*
19th May Points Rd 2 16th Jun Points Rd 3 21st Jul Points Rd 4 18th Aug Points Rd 5 15th Sep AGM – Fun Day 20th Oct Points Rd 6 17th Nov Points Rd 7 8th Dec – Presentation and Xmas Party

P Plate (Probationary) – New Licence holder for the first 3 events*
No Yes

ROF Existing licence holder in a higher class for the first 3 events*
No Yes

Additional Attachments (3mb Max, PDF, JPG, DOC, DOCX)

I agree to abide by the AIDKA 2013 rule book and all current supplementary regulations. I agree as a condition of entry that neither AIDKA, nor the promoters nor the meeting/event organisers nor respective servants, officials, representatives or agents shall be under any liability.

I accept DTKC Code of Conduct

Verification Code, please type the characters you see in the image
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