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2018 – 2019 Associate (Bucket Bike) Membership Application Indemnification and Declaration

I hereby apply for membership/renewal to KARTSPORT WELLINGTON INC. I undertake to abide by the rules of the Club and to pay subscriptions and dues levied by it. I acknowledge the Club’s right to refuse my membership on any grounds and that membership can only be terminated by formal advice in writing. The Club’s financial year ends 31st March.

I/We consent to the collection of the above details by KartSport Wellington Inc. for the purpose of membership record and for KartSport Wellington to retain and disclose these to SPARC, funding agencies and sponsors.

I/We acknowledge my/our rights to access and correction of this information. This consent is given in accordance with the Privacy Act 1993.

The following is applicable only to racing members.

I HEREBY AGREE to fully indemnify the associations known as the FIA, the CIK, the KNZ, the WPKA, KartSport Wellington Inc., the Upper Hutt City Council, the Greater Wellington (Regional) Council, all sponsors and all or any members, officials, assistants or employees or the above named or known organisations against any injury or accident to myself or damage to my kart or equipment whether in practice or competition. Minors (under 18) must have parental or guardian’s signature approving conditions of entry and present during racing or practice and to represent a minor at a judicial hearing.

As an Associate Bucket Bike member of KartSport Wellington, I acknowledge that I have no voting rights.

Membership Year

1 April 2018 – 31 March 2019

Note: Family membership only covers those family members who live at the same address

Family Member 1

Family Member 2

Family Member 3

Family Member 4

Family Member 5

Parent or Guardian

Applicants under 18 years old must included the contact details of a Parent or Guardian


I confirm that I have read and understand the rules and regulations (as above) of being an Associate Bucket Bike member of KartSport Wellington.


Please make your membership cheque payable to “KartSport Wellington Inc.” and forward to the Secretary, PO Box 38 994, Wellington Mail Centre, Lower Hutt OR Pay by Funds Transfer or Credit Card to Westpac bank account 030525 0243128 00 with a reference “MEMBERSHIP (surname)”


Available subject to application to and approval from KartSport Wellington Committee. Application to be made via Key Renewal/Application Form, which can be downloaded and printed out here or filled out online through our website.

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