New Membership Application Name*Address* Street Address Address Line 2 City ZIP / Postal Code Mobile*Phone - HomePhone - WorkEmail* Membership type requested* Ordinary (Senior) $130 Ordinary (Junior, Cadet) $80 Practice (Senior) $130 + $100 refundable levy Practice (Junior, Cadet) $80 + $100 refundable levy Dual (Senior) $130 + $100 refundable levy Dual (Junior, Cadet) $80 + $100 refundable levy Vintage $30 Vintage (voting rights) $130 Associate $30 Associate (voting rights) $130 I agree to be bound by the rules of the club, follow the Driver’s Code of Conduct and the Member Conduct and Practice Rules as laid out in the By-Laws.Do you agree?*YesUnder 18 years of age?YesNoDate of Birth* Date Format: DD slash MM slash YYYY Parent/Guardian name*Phone number (if different to above)Email address (if different to above) As parent/guardian of*Agreement & Consent I consent to him/her becoming a member of the Hurricane Go Kart Club I agree to follow the Parent’s Code of Conduct Acceptance of this application is at the absolute discretion of the committee and shall not become effective until membership fee is received in full by the club.Payment options*CashChequeDirect DepositAccount detailsAccount name - Hurricane Go Kart Club of WA IncBSB - 066112Account number- 1045 8354Address for cheque - 4 Orchard Avenue, Midvale, WA 6056
