Club Membership Form 2019 – 2020 (1st July 2019 to 30th June 2020) Please enter your details below. Membership Membership * Single - $70/yr Family - $95/yr First Name * Last Name * Age * Adult Child Address * [street_Address] [Town] Email Address * Phone Number * Permanent Race Number Partners Details First Name * Last Name * Age * Adult Child Permanent Race Number Other Family Members First Name Last Name Age Child under 18 years of age First Name Last Name Age Child under 18 years of age Release and Indemnity Please note:- Fully read Capricornia Blokart Club Inc. rules & regulations, club release and indemnity, and the Blokart Operation Manual before accepting the conditions below (general rules can be found on Blokart website). For safety reasons all financial members are required to wear seat belts, appropriate footwear and helmets during Blokart activities. Adequate operational training for blokart usage has been supplied. CBC members and associates will not be liable for any injury or damage incurred. Release and Indemnity * I accept the conditions Date * Please enter today's date here Comments or Questions How to Pay * Bank Transfer Cash Payment Due Pay cash to Ian or Paul next time you see them on the beach Payment Due Bank of Queensland Acc Name: Capricornia Blokart Club Inc. BSB# - 124 001 A/C# - 22259504 Place your name and CBC membership in reference section. Join Up Now
