IKF REGULAR MEMBERSHIP APPLICATION …

1 IKF REGULAR MEMBERSHIP APPLICATION INSTRUCTION sheet 1. Effective January 1, 2008, the National MEMBERSHIP is $ and $ for each Family Member. For FIRST-TIME road race applicants, there is a ONE TIME fee of $15 (in addition to your REGULAR MEMBERSHIP ). If applying for a Novice Road Race permit, be sure to include the $15 one time fee. 2. There is no additional fee for Shifter or Sprint TaG licenses. If just renewing your Shifter or Sprint TaG License you do not have to complete the Shifter/TaG APPLICATION . If this is a NEW Shifter or Sprint TaG License a Shifter/TaG APPLICATION must be completed, visit for APPLICATION or contact the IKF office. 3. All National Members must be 18 years of age or older. Family members must be a minimum of 5 years of age. Effective January 1, 2003, Family Members are children under the age of 18 and /or spouse living at the same address.

2 4. Make sure that all handwriting is legible, and ALL information is filled in for National/Family Members. This includes name, address, age, birth date, residence and business phone numbers, and e-mail address if any. Please indicate if you have health insurance. 5. The Agreement must be signed and dated on all applications by the National Member. 6. If the member chooses to pay by credit card, make sure that the credit card number, expiration date, cardholder s name & cardholder s signature are filled in on the APPLICATION . 7. All information on the Parental Consent Release and Waiver of Liability and Indemnity Agreement must be completed and signed by the parent or legal guardian. The Minor s Assumption of Risk and Release and Waiver of Liability must include the minor s printed name, signature and date along with their date of birth.

3 Once completed the document must be notarized on both sides and the original forwarded to the IKF office. If more than one minor, we will need a notarized minor s release form for EACH minor. IKF also requires a Birth Certificate on file for each minor. New MEMBERSHIP REGULAR MEMBERSHIP $ Year ALL PAYMENTS MUST BE IN FUNDS. Renewal, Last Card #: _____ Outside Continent $ Year Includes MEMBERSHIP Card, Patch, Decal, Airmail Additional $ Year Grand Nationals Yearbook, and Rule Book. Check if you would like an patch. ALL NATIONAL MEMBERS MUST BE 18 YEARS OF AGE OR OLDER. Those under 18 must be a Family Member to their parent or legal Member s Name: _____ Age: _____ Birthdate: _____ $ _____Address: _____ Jacket Size: _____City/State: _____ Zip Code: _____Home Phone:( )_____ Wk:( ) _____ Fax:( ) _____E-mail Address: _____Occupation: _____ Do you have Health Insurance?

4 : Yes NoName of Health Insurance Company: _____FAMILY MEMBERSHIP ($ EACH): Family Members must be at least 5 years of age or older. Family Members are a National Member s spouse and/or children under the age of 18. Note: Family members cannot vote and do not receive Karter : _____ Age: _____ Birthdate: _____ Jacket Size: _____ $ _____Name: _____ Age: _____ Birthdate: _____ Jacket Size: _____ $ _____Name: _____ Age: _____ Birthdate: _____ Jacket Size: _____ $ _____ ROAD RACE (ENDURO) LICENSE APPLICATIONNOTE: Novice Road Race license applicants must include a $ one-time fee in addition to their annual MEMBERSHIP Road Racing license may be used to participate in any event (Sprint, Speedway, etc.)All applicants must be 13 years of age during the calendar year. (If you hold a WKA or KART Road Racing license, please enclose a photocopy of it.)

5 Name of License Applicant: _____ $ _____Name of License Applicant: _____ $ _____ ALL CHECKS SHOULD BE MADE PAYABLE TO - PLEASE DO NOT SEND CASH. TOTAL AMOUNT PAID: $ _____ AGREEMENT: (MUST BE DATED AND SIGNED) If accepted as a member by the International Kart Federation, I, (and includ-ing my immediate family, son, daughter, brother, sister, father, mother) agree to abide by the rules and regulations of the organization. I understand that all official publications of the will be sent to me as published during my MEMBERSHIP . I represent that all statements made on this APPLICATION are true to the best of my : _____ Date: _____CHARGE CARD Bill my charge card: VISA MasterCard Card Number: _____ Exp. Date: _____Card Owner s Name: _____ Card Owner s Signature: REGULAR MEMBERSHIP ApplicationAUTOMATIC MEMBERSHIP RENEWAL CONSENT FOR CREDIT CARD APPLICANTS ONLY (MUST BE DATED AND SIGNED) I hereby authorize the IKF to charge my credit card account stated on this MEMBERSHIP APPLICATION for renewal of said applicants on this form.

6 A renewal notice will be sent by the IKF approximatley 30 days prior to my mem-bership expiration and charge date. I agree that any attached Parental Consent Form(s) for any minor Family Member(s) will be valid for 2 years. MEMBERSHIP will not be renewed if credit card is : _____ Date: _____OFFICE USE ONLYPaid: _____Check #: _____Club: _____ _____REVISED 12-18-09 International Kart Federation 33175 Temecula Pkwy, Ste 233, Temecula, CA 92592 Tel: (951) 491-0808 Fax: (951) 491-0809 indicate your participation: Sprint Press Speedway Sponsor Road Race/Enduro Mechanic Shifter Manufacturer Speedway Midget Crew Ta GALL CLAIMS OR DISPUTES AGAINST , ITS DIRECTORS, OFFICERS, OR EMPLOYEES, ARISING OUT OF THIS MEMBERSHIP OR SPONSORED EVENTS IS SUBJECT TO BINDING ARBITRATION, UNLESS THE PARTIES MUTUALLY AGREE OTHERWISE IN WRITING.

7 THE ARBITRATION SHALL BE HELD IN ONTARIO, CALIFORNIA OR OTHER MUTUALLY AGREED UPON VENUE. THE ARBITRATION SHALL BE CONDUCTED BY AN AGREED UPON ARBITRATOR, AND DECIDED IN ACCOR-DANCE WITH THE LAW OF THE STATE OF CALIFORNIA OR CCP 1280 ET SEQ., OR SUCH OTHER LATER ENACTMENT. THE PREVAILING PARTY IN ANY ARBITRATION ACTION SHALL BE AWARDED REASONABLE COSTS AND EXPENSES, INCLUDING EXPERT WITNESS FEES AND ATTORNEY FEES.