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National Winged Outlaw Karts (NWOK)
7567 Seymour Hwy
Wichita Falls, Texas 76310
Send Check or Money Order w/Membership
ANNUAL MEMBERSHIP FEES
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Driver Member License(s) .................................................$60.00
Associate Member(s)............................................................$40.00
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DRIVER MEMBER LICENSE INFORMATION
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Name ______________________________ Age ____ M/F _____ Birth Date _________
Address _______________________________
City/State/Zip_______________________________ E-Mail _______________________
Phone ________________________________ SS# _________________________
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RACING DIVISION (Circle class you are racing)
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125cc 250cc 2 or 4 stroke 500cc
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ASSOCIATE MEMBER(S) INFORMATION
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1) Name ___________________________ Age _____M/F _____ Birth Date _________
Relation: ___________________________
2) Name ___________________________ Age _____M/F _____ Birth Date _________ Relation: ___________________________
3) Name ___________________________ Age _____M/F _____ Birth Date _________ Relation: ___________________________
4) Name ___________________________ Age _____M/F _____ Birth Date_________
Relation: ___________________________
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A Signed Insurance Release from every Member under the age of 18 must be attached with application. Application is subject to approval by Board of Directors.
Signature of Driver_____________________________________ Date_______________
Signature(s) of Biological Parent(s) if driver is under the age of 18 years old.
_____________________________________________________Date_______________
_____________________________________________________Date_______________
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