2022 Registration Emzone Radical Cup Canada Presented by Michelin 2022 Radical Registration Entrant Information 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. Addressee (Name) * Addressee (Name) First First Last Last Address * Address Address 1 Address 1 Address 2 Address 2 City City Province Province Postal Code Postal Code Address Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Team Information Team Name * Team Logo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Team Logo Requested Number * First Choice Requested Number Second Choice Requested Number Third Choice Team Sponsor(s) Sponsor Name Add Another Sponsor Remove Sponsor Team Member Information Series registration includes up 6 hard cards per team (5 Crew Members + Driver). Crew members requiring hard cards must be over 18 years old or must have series permission. Hard Cards are non-transferrable. Additional hard cards are available at $250 each. Please note: Crew who are beneficiaries of Operation Motorsport must be registered through Operation Motorsport Beneficiary Form. DO NOT use this form for Operation Motorsport Crew Members. How many hard cards does your team require? * Select * 1 2 3 4 5 6 Member 1 Member 1 First Name * Member 1 Last Name * Member 1 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 1 Role Member 1 Phone Number * Member 1 Email Address * Member 1 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 1 Emergency Contact First and Last Name * Member 1 Emergency Contact Phone Number * Member 1 Racing Licence Number * Member 1 Sanctioning Body * Member 1 Date of Birth * Member 2 Member 2 First Name * Member 2 Last Name * Member 2 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 2 Role Member 2 Phone Number * Member 2 Email Address * Member 2 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 2 Emergency Contact First and Last Name * Member 2 Emergency Contact Phone Number * Member 2 Racing Licence Number * Member 2 Sanctioning Body * Member 2 Date of Birth * Member 3 Member 3 First Name * Member 3 Last Name * Member 3 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 3 Role Member 3 Phone Number * Member 3 Email Address * Member 3 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 3 Emergency Contact First and Last Name * Member 3 Emergency Contact Phone Number * Member 3 Racing Licence Number * Member 3 Sanctioning Body * Member 3 Date of Birth * Member 4 Member 4 First Name * Member 4 Last Name * Member 4 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 4 Role Member 4 Phone Number * Member 4 Email Address * Member 4 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 4 Emergency Contact First and Last Name * Member 4 Emergency Contact Phone Number * Member 4 Racing Licence Number * Member 4 Sanctioning Body * Member 4 Date of Birth * Member 5 Member 5 First Name * Member 5 Last Name * Member 5 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 5 Role Member 5 Phone Number * Member 5 Email Address * Member 5 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 5 Emergency Contact First and Last Name * Member 5 Emergency Contact Phone Number * Member 5 Racing Licence Number * Member 5 Sanctioning Body * Member 5 Date of Birth * Member 6 Member 6 First Name * Member 6 Last Name * Member 6 Role * Select * Team Manager Crew Member Driver Other *Please Specify* Member 6 Role Member 6 Phone Number * Member 6 Email Address * Member 6 Photo * Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Photo Member 6 Emergency Contact First and Last Name * Member 6 Emergency Contact Phone Number * Member 6 Racing Licence Number * Member 6 Sanctioning Body * Member 6 Date of Birth * Radical Car Information Radical Year * Radical Model * Select * SR3 SR3 RS SR3 RSX SR3 XX SR8 SR10 Other *Please Specify* Radical Model Transponder No. * Series Registration Payment Options Total series fees include Series Registration ($2,145.00 + taxes) + 5 Race Weekends ($2,145ea + taxes). Pay in Full OR Select Races: Payment * Select * Full payment in advance Select Races Product * Full payment in advance: $ 14,543.10 CAD Product * Series Registration Fee (Mandatory): $ 2,423.85 CAD Product Race 1, Race 2 (May 20,21,22 @ Canadian Tire Motorsport Park) $2423.85 Race 3, Race 4 (June 3,4,5 @ Calabogie Motorsports Park) $2423.85 Race 5, Race 6 (June 7-10 @ Watkins Glen International) $2423.85 Race 7, Race 8 (August 19,20,21 @ Calabogie Motorsports Park) $2423.85 Race 9, Race 10 (September 2,3,4 @ Canadian Tire Motorsport Park) $2423.85 Total Checkboxes * By checking this box, I agree to all the terms and conditions. Payment Method * Select * Paypal Credit Card E-Transfer Credit Card * Having trouble with your payment? Click Here to Restart If you are human, leave this field blank. Submit
