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 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 * Team Logo * Drop a file here or click to upload Choose File Maximum file size: 67.11MB Team Logo Requested Number * First Choice Requested Number Second Choice Requested Number Third Choice Team Sponsor(s) Sponsor Name plus1 Add Another Sponsor minus1 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 *123456 Member 1 arrowup6 Member 1 First Name * Member 1 Last Name * Member 1 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 arrowup6 Member 2 First Name * Member 2 Last Name * Member 2 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 arrowup6 Member 3 First Name * Member 3 Last Name * Member 3 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 arrowup6 Member 4 First Name * Member 4 Last Name * Member 4 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 arrowup6 Member 5 First Name * Member 5 Last Name * Member 5 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 arrowup6 Member 6 First Name * Member 6 Last Name * Member 6 Role * Select *Team ManagerCrew MemberDriverOther *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 file 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 *SR3SR3 RSSR3 RSXSR3 XXSR8SR10Other *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 advanceSelect 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 *PaypalCredit CardE-Transfer Credit Card * Having trouble with your payment? Click Here to Restart If you are human, leave this field blank. Submit
