Renewal Licence by v143d0S9


									 2011/2012 Membership

Surname:                                                                                      FOB No:
Address:                                                                                      Home Phone:
Suburb:                                                                                       Work Phone:
Post Code:                                                                                    Mobile:
     Please tick if you wish to receive renewal notices or information from GKCV at this email address .

Member(s) Detail:
                                                                                  Licence       Licence        Licence           Race Class & No
#          First Name         Date of Birth             Affiliated Club
                                                                                     No          expiry         grade
Primary contact:
Additional Family members (only for Family Memberships):

Part A: New or Renewal                                                             Part B: Membership Type
Please tick one                                                                    Please tick one

 New Membership                                                                   Cadets                                                 $190
                    Joining Fee
                                                                 $135               Rookie                                                 $190
                    Gate FOB Fee
                                                                 $15                Junior                                                 $190
               Includes 3 complimentary entry for club day                          Senior                                                 $220
 Renewal Membership                                                               Family                                                 $260
    denotes a one time payment for new membership only
                                                                                                            Total Fees Due to Club:          $

AKA Licence Information:                                                         Notes:
                                                                                 1. New or Renewal of Membership or Licence application are
New Licence:              Senior/Junior                         $300                processed via an approved Karting shop.
                          Cadets/Rookie                         $300             2. When making payments, two cheques are required.
                                                                                    (a) To "Victorian Karting Association" for Licence payment.
Renewal Licence           Senior/Junior                         $280                (b) To "Go Kart Club of Victoria" for Membership payment.
                          Cadets/Rookie                         $280             3. Cash will NOT be accepted.
                                                                                 4. Members of other affiliated clubs please note that no joining fee will
                          Late payment, after 30days            $300                apply if you are a current financial member of another affiliated club.
                                                                                 5. For additional information regarding Membership/Licences or about
                                                                                    the Club, refer to our web site

Conditions of Membership:
 It is a condition of membership that you observe the rules of the Australian Karting Association (AKA) and the Go Kart
 Club of Victoria (GKCV) regarding all conduct both on and off the race track. Please be aware that our circuit is
 licensed for competition use only and your conduct is in accordance with the competition rules of the association.
 Breach of these rules may result in cancellation of your membership and licence.

 I have read & understand the GKCV Membership conditions listed above.

 Applicant’s Signature:______________________________ Date:_______________

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