2018 Australian Open Blokart Championships Individual Competitor Registration Form. Step 1 of 3 33% Welcome, lets get started!How would you like to register?*Web-based Form (Recommended)Paper-based FormLate fee apples from 22-12-2017Entry to the Australian Open Blokart Championships is now open and closes on 22nd December 2017. Late registration/payment penalty of $50AUD will apply.You've selected to register via a paper-based form. Please download & complete THIS FORM Then email it to Events@PerthBlokartClub.com.au You may close this window.Name* First Last Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Gender*MaleFemalePhone / Mobile* Your Weight Class*(Select one)Light Weight - Under 70KgMedium Weight - 70Kg to 82.5KgHeavy Weight - 82.5Kg to 95KgSuper Heavy Weight - 95kg and aboveYour Club*(Select one)ABA / IBRA MemberNon-MemberYour Registered Club*Your Blokart(s)ABA / IBRA MemberSelect ClassSingle ClassDual ClassYour Blokart(s)Non-ABA / IBRA MemberSelect ClassSingle ClassDual ClassYour First BlokartClass of First BlokartSelect ClassProductionPerformanceSailing Number of First BlokartYour Second BlokartClass of Second BlokartSelect ClassProductionPerformanceSailing Number of Second Blokart Presentation Dinner - RSVP*Yes, attending Presentation DinnerNo, not attending Presentation DinnerTotal Guests #?*Total number of guests (including yourself)Please enter a value between 1 and 9.Guest ListPlease enter their namesTotal (AUD) $ 0.00 Event Information Organising Body: Perth Blokart Club Inc Email: Events@PerthBlokartClub.com.au Release & Indemnity - Australian Blokart Association in conjunction with Perth 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 Perth 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 Association or the Perth Blokart Club, I further agree to indemnify and hold harmless each of them of and from any and all claims, demands or action of any kind or nature whatsoever arising out of any injury or damages incurred by the registered participant. There will be no refunds in the event of cancellation. Weight categories - These may be changed at the discretion of the organizers depending on entry numbers. Competitors will be weighed at the event and weight divisions will be allocated by the race committee. 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 Privacy - The information given on this form is for the use of the organisers and sponsors only. Your information is sent to this site using SHA256 SSL encryption. This information is collected for administration purposes and is held by the Perth Blokart Club - 15 Concord place, Connolly 6027 Western Australia By ticking the box below you've read and understood the Notice of Race and to the Event Information outlined above.You agree to the Event Information above?* Yes, I Agree EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.