MIKA Event Registration
M.I.K.A EVENT
Choose the event you are registering for from the check list.
*
M.I.K.A RACE 6
M.I.K.A RACE 7
M.I.K.A RACE 8
M.I.K.A RACE 9
M.I.K.A RACE 10
Personal Information
Driver's Name
*
Email
*
Address
*
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Phone #1
*
Phone #2
Emergency Contact - Name
*
Emergency Contact - Phone Number
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Age
*
Karting Information
Please ensure that you use the Kart number issued to you when you purchased your National Karting Licence. The kart number issued to you is on the back of your National Karting Licence
Your Transponder Number
Club Membership Affiliation
*if you are affiliated to another team or club from another track please indicate it here.
Mechanic Name
Classes
1st Entry ($90.00 CAD + HST)
*
Please Select
BRIGGS CADET
BRIGGS JR LITE
BRIGGS JUNIOR
BRIGGS SENIOR
BRIGGS MASTER
MINI ROK
JUNIOR ROK
SENIOR ROK
MASTER ROK VLR
125CC SHIFTER ROK
Kart Number (1st Entry)
2nd Entry ($80.00 CAD + HST)
Please Select
BRIGGS CADET
BRIGGS JR LITE
BRIGGS JUNIOR
BRIGGS SENIOR
BRIGGS MASTER
MINI ROK
JUNIOR ROK
SENIOR ROK
MASTER ROK VLR
125CC SHIFTER ROK
Kart Number (2nd Entry)
MANDATORY FORM/WAIVERS
Please ensure that you print, sign/fill out all applicable waivers and the tech form below.
General Waiver & Release Form
Parental Consent Form
Minor Participant Form
Technical Inspection Self-Declaration Form
Additional Options
Pre-event practice on Friday ($65 + HST)
Price:
$ 65.00 CAD
Quantity:
Pre-Order Race Day Fuel (FUEL VP CAN - 5 GAL - $120.00 + HST)
Price:
$ 120.00 CAD
Quantity:
Pre-Order Race Day Oil (MOTUL OIL 2T - $32.04 + HST)
Price:
$ 32.04 CAD
Quantity:
Pre-Order Tires
VEGA BLUE SLICK 6.50 / 4.50 SET ($255.00 + HST + TIRE TAX)
Price:
$ 255.00 CAD
Quantity:
VEGA BLUE SLICK 4.50 / 4.50 SET ($240.00 + HST + TIRE TAX)
Price:
$ 240.00 CAD
Quantity:
VEGA W5 RAIN TIRE SET ($295.00 + HST + TIRE TAX)
Price:
$ 295.00 CAD
Quantity:
BRIDGESTONE YLR 7.10 / 4.50 SET ($285.00 + HST + TIRE TAX)
Price:
$ 285.00 CAD
Quantity:
BRIDGESTONE YLR 4.50 / 4.50 SET ($269.00 + HST + TIRE TAX)
Price:
$ 269.00 CAD
Quantity:
BRIDGESTONE YLP RAIN TIRE 650 / 450 SET ($305.00 + HST + TIRE TAX)
Price:
$ 305.00 CAD
Quantity:
Note: All Tires, Fuel & Oil ordered here will be available onsite at the track registration check-in
Total
Total payable amount
TIRE TAX
Price:
$ 0.00 CAD
HST 13%
Price:
$ 0.00 CAD
Total including HST and Tire Tax (if applicable)
$ 0.00 CAD
Comments
This field is for validation purposes and should be left unchanged.
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