Waiuku Dirt Track Club Membership 2023/24 Season

*

Membership Renewal

New Member

Name *

Phone *

Drivers License # (if applicable)

Date of Birth (if under 18)

Email Address *

Car Number (leave blank if you don't have one yet)

Class *

Membership *

Social Membership ($45)

Full Membership ($65)

Junior Membership ($45)

I wish to apply for membership to the Waiuku Dirt Track Club & accept that on becoming a member the Management Committee & other members shall require me to abide by the Constitution, Rules & Regulations which govern the functions of the club

Payment can be made through Internet Banking to: 02-0476-0086495-00 please include car number and surname as reference, or via EFTPOS/CASH on sign up night or prior to first race meeting

Please tick here if you have paid online *

Yes	No - will pay via eftpos

Junior	Junior Ministocks	4 Cyl Production	4 Cyl Open
6 Cyl Production	6 Cyl Open	8 Cyl	Open Saloons
Fender Benders	Ladies	Mechanics	Leftie Modifieds (open)
Leftie Saloons (closed)	Other (UTV/4WD for forest only)