Emzone Radical Cup Canada Sign up for individual races 2023 Emzone Radical Races Entrant Information The Entrant shall be deemed as the Team Representative for the duration of the season. Please see Articles 2.5 and 2.6 of the Sporting Regulations for details regarding Registration Procedures and Entrant Responsibility. Entrant First Name * Entrant Last Name * Entrant Phone Number * Entrant Email Address * A copy of this form will be sent to this email address. Confirm Entrant Email Address * Confirm email address Address The address entered will be kept on file for shipping series assets. Address (Name) * Address (Name) First First Last Last Address * Address Address 1 Address 1 Address 2 Address 2 City City Province Province Postal Code Postal Code Address AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Team Information Team Name * Vehicle Number 123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899 Series Registration Payment Options Prices are subject to changes and taxes. Online payments are subject to a proccesing fee. Apply discount code before selecting product type for discount to be applied. Discount code 10% discount applied on Total Product Event 1 (May 19,20,21 @ Canadian Tire Motorsport Park) $ 5,995.00 CAD +HST Product Event 2 (July 14,15,16 @ Honda Indy Toronto) $ 5,995.00 CAD +HST Product Event 3 (August 19, 20 @ Calabogie) $ 5,995.00 CAD +HST Product Event 4 (September 1, 2, 3 @ Canadian Tire Motorsport Park) $ 5,995.00 CAD +HST Total 10% discount applied on Total Checkboxes * By checking this box, I agree to all the terms and conditions. Payment Method * Select * PaypalCredit CardE-TransferChequeWire Transfer Please make cheques out to: Franczak Enterprises Canada Ltd. 23 Hannover Drive St. Catharines, Ontario L2W 1A3 Credit Card * A non-refundable 3% processing fee is automatically applied to all Credit Card and PayPal transactions. Having trouble with your payment? Click Here to Restart If you are human, leave this field blank. Submit
