REGISTRATION FORM

WAY 1: Complete the Entry Form online

Last Name

First Name

Gender:  Female Male

Address

City

State:

ZIP code

Country

Email

Phone #

Profession

Company

Date of Birth

Birth Country

Height Weight

Shoe size Helmet size

I have my Racing Gear  Yes No

I own a Racing License  Yes No

Name on License

License number

Type of License

Previous Racing Experience

Emergency Contact Name and Phone Number

Bringing guest  Yes No

Number of guests

Allergies or Medical Conditions

TRACK DAYS AND RACES

> 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 Days Double Sprint Race

Auto Club Speedway: May 7,8
 Track Days

Laguna Seca: May 20, 21, 22
 Track Days Double Sprint Race

Auto Club Speedway: May 28, 29
 Track Days

Auto Club Speedway: June 11, 12
 Track Days Double Sprint Race

Sonoma: July 16, 17
 Track Days Double Sprint Race

Auto Club Speedway: August 13, 14
 Track Days

Sonoma: August 26, 27, 28
 Track Days Double Sprint Race 6-hour Endurance Race

Buttonwillow: September 17, 18
 Track Days Double Sprint Race

Auto Club Speedway: October 1, 2
 Track Days Double Sprint Race

Auto Club Speedway: November 5, 6
 Track Days

Las Vegas: November 11, 12, 13
 Track Days Double Sprint Race 6-hour Endurance Race

2016 PRICING

At Laguna Seca, Auto Club Speedway, Sonoma, or Buttonwillow racetrack

 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

At Circuit of the Americas - April 28-29, May 1

 Track Day: 4 X 25-minute lapping sessions - $4,990

> 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 - $14,990

EXR Sprint Series Gold Package

 16 sprint races (8 race weekends) Full season - $79,990

Prices excludes

- Driver's transportation to/from racetrack
- Meals during the event
- Accomodation

CREDIT CARD AUTHORIZATION

Type of card  Visa MasterCard American Express Discover

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.

WIRE TRANSFER

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)

BANK CHECK

Payment can be done by Bank Check made payable to: Exotics Racing Series, LLC.

AGREEMENT

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.

WAY 2: Download and complete the PDF Entry Form and send it to us here:

DOWNLOAD 2016 ENTRY FORM

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