2011 Queensland Blokart Titles

2015 Australian Open Blokart Championships Entry Form Organising Body: Capricornia Blokart Club

The 2015 Australian blokart Open runs from the 27th to the 30th of March 2015 and is to be held on Mulambin Beach at Capricorn Palms Holiday Village, Yeppoon, Queensland, Australia. National and International competitors will compete in Production or Performance categories in their weight divisions for the champion’s title in short course races and a separately scored marathon. Friday: Practice/Registration, Saturday- Sunday short course racing, Monday marathon. For full details please read the Notice of Race document.

Complete electronically and email to [email protected] or copy, fill in and post ASAP)

Name: (first) (last) Gender (select): Male / Female Postal Address: Country: Land Phone: Mobile Phone: 04 Email (mandatory): Club: Race Number (Please supply your registered number): Or (preferred number (must be in early) or can be supplied): Estimated race weight kg Weight categories may be changed at the discretion of the organizers depending on entry numbers. Racers will be weighed at the event and weight divisions will be allocated by the race committee.

Category: _ Performance /Production / Both Note: IBRA rules apply. Competitors may enter in either Production or Performance blokarts or both. Production and Performance blokarts will race separately to allow competitors to compete in both categories. However please note that races will not be delayed for competitors to change karts between races. If you enter in dual categories it is your responsibility to be ready for racing in each category. Transponders and whip numbers need to be transferred for each class or separate transponders can be hired. It is proposed that each category will be spilt in to four weight divisions:-  Light Weights: under 70kg  Middle Weights: 70kg and up to 82.5kg  Heavy Weights: 82.5kg and up to 95kg  Super Heavy Weights: 95kg and over These weight divisions are approximate. The organisers have the authority to modify the specified weights depending on the number of entries in each division. SCHEDULE Late Entry Fee Starts Sat 28th Feb 2015 All entries close Fri 27th Mar 2015

Practice Fri 27th Mar 2015 Registration, Scrutineering 3.00pm to 6.00pm Fri 27th Mar 2015 Registration, Scrutineering 7.30am to 8.30am Sat 28th Mar 2015 Competitors Briefing 9.30am Sat 28th Mar 2015 Race Day 1 Sat 28th Mar 2015 Dinner 6.30pm Sat 28th Mar 2015 Race Day 2 Sun 29thMar 2015 BBQ 6.00pm Sun 29thMar 2015 Marathon & briefing 9.30am Mon 30th Mar 2015 Presentation ASAP after racing Mon 30th Mar 2015

Entry Fee Competition entry fee includes buffet dinner for one person on Saturday evening, a BBQ dinner on Sunday for one person, electronic timing, race insurance & Great Aussie hospitality. Additional meal tickets for partners & kids may be purchased.

Entry Fee paid before 28th February ABA/IBRA club member $ 95 Non-ABA/IBRA member $120 Entry Fee paid after 28th February ABA/IBRA club member $145 Non-ABA/IBRA member $170 Dual Entry. Entry into second category $ 40 Extra Race numbers (one supplied) $ 6 Race Entry Fee AU$ Transponder Hire @ $20.00 each if you do not have a compatible AMB/Mylaps one. Transponders may be purchased for $170 each. Transponder Purchase AU$ Or Transponder Hire AU$ Catering for Saturday Evening Dinner at Keppel Bay Sailing Club: Race entry fee includes one complimentary meal on Saturday night. I wish to include (number) extra person/s in the meal at $40 pp. I wish to include (number) extra kids in the meal at $15.00 each (4-12 years) Extra Meals AU$ Catering for Sunday Evening BBQ at Capricorn Palms Holiday Village: Race entry fee includes one complimentary BBQ on Sunday night. I wish to include (number) extra person/s in the BBQ at $10 pp. I wish to include (number) extra kids in the BBQ. Free for kids under 12 years Extra BBQ AU$ Total Amount Payable AU$ Payment Details Cheque or Bank Transfer (circle) International visitors can pay at registration.

Cheque: make out to Central Region Development Committee and Post to: Paul Effeney, 6 Bowls Street, Yeppoon, 4703. Qld Australia

Contact Phone: 07 49383173 Contact e-mail: [email protected] Mobile: 0407 157 523 Bank Transfer Account Name: Central Region Development Committee Bank: ECU B.S.B No: 654019 A/C Reference# 338217S20 Please ensure to put your full name on the transfer.

Release and Indemnity Australian Blokart Association in conjunction with The Capricornia Blokart Club will take all reasonable steps to safeguard every competitor in the Australian blokart Open. In consideration for your permitting registration of this child(ren) or yourself to participate in the following blokart sailing activities, the participant(s) does hereby release Australian Blokart Association and The Capricornia Blokart Club and all affiliated and 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 such activities, including any personal injury or death which may be suffered or incurred as a result of participation in such activities whether or not caused by the negligence or wrongful acts of such persons or any agents or members of the Australian Blokart Association or the Capricornia Blokart Club, I further agree to indemnify and hold harmless each of them of and from any and all claim, demands or action of any kind or nature whatsoever arising out of any injury or damages incurred by the registered participant. No refunds in the event of cancellation.

I have read the Notice of Race and this Entry form and agree to the Terms and Conditions listed in these documents.

Signed:______Date: / /

E-mailed entries are to be signed by the participant (or Legal Parent/Caregiver) at registration. Payment of entry fee constitutes agreement of all conditions listed in the Notice of Race and the Entry form.

Privacy: The information given on this form is for the use of the organisers and sponsors only. This information is collected for administration purposes and is held by the Capricornia Blokart Club, 6 Bowls Street, Yeppoon, Queensland 4703, Australia. Confirmation and any further details will be sent to you via email.