MICHIGAN KART CLUB

                                      Membership Application

Master Member:

Name:                                                   AMB Transponder No:

Address:

City:             State:       ZIP:

Daytime Phone:                                       Evening Phone:

Age:      Birth Date:                    Email:

WKA Mem. No.                   Expiration Date:

Race Committees Preferred:                           SSN: (Last 4 Digits)

Associate (Family) Member Residing at Same address:

Name:                                                   AMB Transponder No:

Email:

Age:      Birth Date:                                SSN: (Last 4 Digits)

WKA Mem. No.                  Expiration Date:

Race Committees Preferred:

Associate (Family) Member Residing at Same address

Name:                                                   AMB Transponder No:

Email:

Age:      Birth Date:                                SSN: (Last 4 Digits)

WKA Mem. No.                  Expiration Date:

Race Committees Preferred:

Race Committees: Scoring (A), Registration (B), Grid (C), Track Race Kart Pickup (D), Scales

(E), Fuel Tech (F)

Club members receive a Monthly Newsletter, Monthly Membership meetings, Awards Banquet

featuring door prizes and special awards.

Earn Club Class Championship year-end awards by working for a Race Committee at Club Races

for one hour each weekend per class. You start earning points the day you join.

Annual Dues: $15

Make Check Payable to:

Michigan Kart Club, Inc. (US Funds only)

Mail to:

MKC

9952 Niver

Allen Park, MI 48101