Mosport Karting Centre » MIKA – MEMBERSHIP REGISTRATION

Personal Information

Name*

First Last

Driver's Name*

Email*

Address*

Street Address Address Line 2 City Province Postal Code

Phone #1*

Phone #2

Date of Birth*

Age*

Are you a Rookie?*

Yes
No

Classes

1st Entry - $175 + HST*

Kart Number (1st Entry)

2nd Entry ($50.00 CAD + HST)

Kart Number (2nd Entry)

Mika Additional Family Driver

Do you want to add an additional Family Driver?

Yes

Driver's Name*

Date of Birth*

1st Entry $120 + HST*

Kart Number (1st Entry)

2nd Entry ($75.00 CAD + HST)

Kart Number (2nd Entry)

Additional Options

Please visit our store for additional options such as Associate Membership (Non-driver), Paddock Spot Area and Seasonal Practice Pass.

Agreement

Agreement*

Yes*

I / WE agree to respect the Mosport International Karting Association and understand that membership to MIKA is granted as a privilege to members who participate within the rules set forth in the MIKA MEMBERSHIP INSTRUCTIONS and Application + Waiver

Consent

Parent / Guardian’s Name

Members under 18 years of age must have their parent or guardian to fill out this application and agree with the Waiver.

Total

Total payable amount

HST 13%

Price: $ 0.00 CAD

Coupon

Total including HST

$ 0.00 CAD

Name

This field is for validation purposes and should be left unchanged.

MIKA – MEMBERSHIP REGISTRATION