Membership Form | Capricornia Blokart Club, Yeppoon, Queensland

Club Membership Form!

2023 – 2024 (1st July 2023 to 30th June 2024)

This form can be used for renewing your membership or applying for membership.

Membership fees are discounted until the 31st July 2023.

When applying to join the Capricornia Blokart Club you must be nominated and seconded by existing members of the club.

Please enter your details below:

Membership

Membership renewal / application *

Renewal of existing membership

New Application for membership

Membership Type *

Single - $80/yr

Family - $105/yr

Youth - $30/yr

First Name *

Last Name *

Date of Birth *

Address *

Email Address *

Phone Number *

Permanent Race Number

Partners Details

First Name of other family member

Last Name of other family member

Date of Birth

Permanent Race Number

Other Family Members

First Name of other family member

Last Name of other family member

Date of Birth

First Name

Last Name

Date of Birth

Proposer and Seconder for new Members

Proposer First Name

Proposer Last Name

Seconder First Name

Seconder Last Name

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 or transfer the money to the bank. Bank Of QLD Account Name: Capricornia Blokart Club BSB: 124001 Account: 22259504

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Capricornia Blokart Club, Yeppoon, Queensland

Yeppoon’s beaches were made for Sand Yachting! Everyone can enjoy land sailing.

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Phone

0481 058 088

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Email

Please click here

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