Bash Entry Form 2023
First Name
*
Last Name
*
Gender
*
Female
Male
Age
*
Adult
Child
Email Address
*
Phone
Club
*
Will you have a shadow?
Yes
No
Will you have a deuce bar?
Yes
No
Entry Fees
The entry fee for existing Capricornia Blokart Club Inc. members and members of other affiliated Blokart Clubs is $25 per adult. Children are free.
Blokart Club Member $25 per person
*
Enter number of competitors here
Sub Total $
Release and Indemnity
Capricornia Blokart Club Inc. will take all reasonable steps to safeguard every competitor in the Capricornia Blokart Bash 2023. In consideration of your permitting registration of this child/ren or yourself to participate in the above Blokart sailing activities, the participant/s do hereby release Capricornia Blokart Club Inc. and all affiliated and/or associated organisations, together with their representatives, members or agents, of and from any and all demands of any kind or nature whatsoever, arising out of or in any way related to any participation in activities such as and including personal injury or death which may be suffered or incurred as a result of participating in such activities, whether or not caused by the negligence or wrongful acts of such persons or any agents or members of the Capricornia Blokart Club Inc. The participant/s further agree to indemnify and hold harmless each of them of and from any and all claims, demands, or actions of any kind or nature whatsoever arising out of any injury or damages incurred by the registered participant.
Electronic lodgement constitutes agreement with conditions.
Please pay by direct transfer to our acount. Capricornia Blokart Club Inc. BSB: 124 001 Account No: 22259504. or you can cash when you arrive at registration.
Total Payment Due
Entry Fees $
Please pay by direct transfer to our acount. Capricornia Blokart Club Inc. BSB: 124 001 Account No: 22259504. or you can pay with cash when you arrive at registration.
Release and Indemnity
*
I accept the conditions
Date
*
Please enter today's date here
Submit