Come Race With Us:
Last Name
First Name
Gender: FemaleMale
Address
City
State: AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
ZIP code
Country
Email
Phone #
Profession
Company
Date of Birth
Birth Country
Height Weight
Shoe size Helmet size
I have my Racing Gear YesNo
I own a Racing License YesNo
Name on License
License number
Type of License
Previous Racing Experience No Racing ExperienceGo-kart amateurGo-kart professionalCar racing amateurCar racing experienced/advancedCar racing professionalJust a Fan
Emergency Contact Name and Phone Number
Bringing guest YesNo
Number of guests ---1234566789101112131415
Allergies or Medical Conditions
> Track Days are available during every race weekend > Each race weekend include a double sprint race
Select your choice:
Circuit of the Americas: April 29-30, May 1 Track DaysDouble Sprint Race
Auto Club Speedway: May 7,8 Track Days
Laguna Seca: May 20, 21, 22 Track DaysDouble Sprint Race
Auto Club Speedway: May 28, 29 Track Days
Auto Club Speedway: June 11, 12 Track DaysDouble Sprint Race
Sonoma: July 16, 17 Track DaysDouble Sprint Race
Auto Club Speedway: August 13, 14 Track Days
Sonoma: August 26, 27, 28 Track DaysDouble Sprint Race6-hour Endurance Race
Buttonwillow: September 17, 18 Track DaysDouble Sprint Race
Auto Club Speedway: October 1, 2 Track DaysDouble Sprint Race
Auto Club Speedway: November 5, 6 Track Days
Las Vegas: November 11, 12, 13 Track DaysDouble Sprint Race6-hour Endurance Race
Track Day: 4 X 25-minute lapping sessions - $3,990
> Add-ons
On-board video and data - $99
3-lap ride-along - $299
Driver's gear rental - $299
One day private coaching - $990
> Races
Double-Sprint Race - $9,990
Endurance Race - $16,990
Track Day: 4 X 25-minute lapping sessions - $4,990
Double-Sprint Race - $14,990
EXR Sprint Series Gold Package
16 sprint races (8 race weekends) Full season - $79,990
- Driver's transportation to/from racetrack - Meals during the event - Accomodation
Type of card VisaMasterCardAmerican ExpressDiscover
Credit Card Number
CVC Code
Expiration date
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company: so long as the transaction corresponds to the terms indicated in this form.
City National Bank 555 South Flower Street Los Angeles, CA 90071 ABA or Routing Number: 122016066 Beneficiary: Exotics Racing Series DDA: 370170207 Swift Code: CINAUS6L (for international wires)
Payment can be done by Bank Check made payable to: Exotics Racing Series, LLC.
I wish to register for this program of the 2016 EXR Racing Series. I therefore hereby agree to comply with the relevant technical and sporting rules. I also hereby release EXR Racing Series, its members, related entities, agents, officers, directors and assigns as released parties and from all liability on account of bodily injury, with or without liability, occurring during a program/meeting or a driving session using a EXR Racing Series race car. EXR Racing Series reserves the right to change the calendar of events at any time.
Enter your email address for unsubscription.
Newsletter subscription! Add your email address and your name, than click subscription button.
