2018/19 DIT Karting Membership Form
Welcome to DIT Karting Club! Please fill out this short form to become a member of the club. All information provided will be kept strictly confidential.

There is a small sign-up fee of €2!

Name *
BLOCK CAPITALS please - i.e. JOHN SMITH
Your answer
Date of Birth *
Your answer
Student No. *
i.e. Cxxxxxxxx or Dxxxxxxxx
Your answer
Course Code
i.e. DT001
Your answer
What year are you in? *
Contact No. *
Mobile (i.e. 0851111111) or landline (include area code i.e. "01" for Dublin)
Your answer
E-Mail Address *
Your answer
Important information
This information is essential - You CANNOT race without providing it.

Your emergency contact must be an Irish number.

Emergency Contact Name *
BLOCK CAPITALS please i.e. MARY SMITH
Your answer
Emergency Contact Number *
Mobile (i.e. 0851111111) or landline (include area code i.e. "01" for Dublin)
Your answer
Medical Conditions
Please note: we should be made aware of any Medical Condition/s you may have and/or any medication you may be taking, which may affect you while participating in any event, activity or sport organisation by the Clubs, Volunteering and/or Societies. This will be kept confidential.
Your answer
Health & Safety Requirements *
I agree to observe, in addition to the laws of the state, the regulations of the institute as amended from time to time by the Governing body and other codes of practice as issued by the officers of the Clubs, Volunteering and/or Societies. A copy of the DIT regulations and the DIT Clubs, Volunteering and Societies codes of practice can be located on the DIT website - www.dit.ie
Our first events are on next Wednesday and Thursday at Kart City Raceway, Santry! *
If you are interested in going please talk to a member of the committee!
Membership Fee *
Please see a member of the committee to pay your membership fee of €2!
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