Registration ends May 31 2018
Sanctioned MWA Tracks for 2018 Competition will compete in National and State point championships
Drivers Name: Mini Wedge #:
Address:
City: State: Zip Code:
Driver's Birthday: / /20 Gender: (circle one) M / F
Driver's Jacket Size:(circle one) Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large
Parent or guardian, must be over the age of 18
Name:
Address: LEAVE BLANK IF SAME AS DRIVER
City: State: Zip Code:
Phone Number: Email:
I agree to the rules and regulation of the Mini Wedge Association and any waiver I sign in regards to racing. I understand that Kart racing can be dangerous and can cause injury or death, and that everything possible is done to make the event as safe as possible, but the nature of kart racing does involve risk. Any participant will not hold Mini Wedge Association liable for any property damages, injuries or death.
Signature of Guardian:
Print Name: Date:
Send this signed form and check or money order for $25.00 to address listed below OR email completed form to HMChassis@yahoo.com
Make checks or money orders payable to Mini Wedge Association.
You can also pay by PayPal, Visa, Discover and MasterCard by calling Jeramy Lange, 231-571-5184
Mini Wedge Association
1180 Bolen Rd
Muskegon MI, 49442
Internal Use Only
Date Received: Restrictor Plate SN:
Region: Motor Serial No:
Paid by: Motor Serial No: