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  2012 Skusa Membership and Licensing Application



 
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Required for all SKUSA, and ProKart Events and Provides the following benefits:
  • Earn series championship points
  • Reserved race numbers
  • Eligibility for purses
  • Eligibility for event and end of series prizes

Note: Drivers under 18 years of age are required to have their parents print, complete and sign the 2012 SKUSA Membership and Licensing Application Form. It should then be faxed to SKUSA at (951) 491-0809 or scanned and emailed to info@superkartsusa.com or mailed to SKUSA, 33175 Temecula Pkwy, Ste. 233, Temecula, CA 92592 -- along with a clean copy of the driver's birth certificate.

Price: $75.00


Mandatory fields are marked *.

Licensee Information

First Name*:

Middle Name*:

Last Name*:

Street Address*:

City*:

State*:

Zip/Postal Code*:

Country*:

Daytime Phone*:

Evening Phone*:

Email Address*:

Date of Birth*:

Driver Height*:

Driver Weight*:
Race Number

Primary Race Number*:

1st Alternate*:

2nd Alternate*:
Race Classes and License

Select Your Race Classes: 		SuperPro / KZ2 - A or B License Only

 S1 Pro Stock Moto - A License Only

 S2 Semi-Pro Stock Moto - B License Only

 S3 Novice Stock Moto - C License Only

 S4 Masters Stock Moto - B or C License

 S5 Junior Stock Moto - D License Only

 G1 Master ICC - B or C License

 TaG Cadet - D License

 TaG Junior - D License Only

 TaG Senior - B or C License

 TaG Master - B or C License

Local Option Class:

License Type you are applying for: 		  
Experience and License Upgrade

Racing History*:

Requesting an Upgrade?:

Qty:
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