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Racing Driver's Registration RACING DRIVER’S REGISTRATION Please fill in your information in the designated lines below. Sign and return to: [email protected] Last name First name Female Male Address City State Zip code Country Phone # E-mail Profession Company Date of birth / / Birth Country Height Weight Shoe size Helmet size I have Racing Gear Yes No I have a Racing License Yes No Sanctioning Body / Grade License Number Sponsors ____________________________ Road Driver’s License # State Issued Previous Racing Experience Emergency Contact Name Relationship Phone # Bringing guest Yes No # of guests Allergies or Medical Conditions Revised: 1/4/2017 6925 Speedway Blvd C-105 Las Vegas, NV 89115 Page | 1 exrseries.com / [email protected] / O : +1(702)802-5650 Please fill in your information in the designated lines below. Sign and return to: [email protected] 2017 EXR SERIES SCHEDULE PLEASE SELECT YOUR CHOICES Double Endurance Race Month Day Track Sprint Race Jan 21 & 22 EXR Las Vegas Mar 4 & 5 Homestead Miami Mar 18 &19 Road Atlanta Apr 29 & 30 Sebring International Raceway May 19 to 21 EXR Las Vegas Jun 23 to 25 Mazda Raceway Laguna Seca Aug 4 to 6 6H of Utah Motorsports Park Sep 9 & 10 Sonoma Raceway Oct 7 & 8 Auto Club Speedway Oct 28 & 29 Sonoma Raceway Nov 10 to 12 24H of Circuit of The Americas Nov 17 to 19 EXR Las Vegas Dec 2 & 3 25H of Thunderhill Raceway Park 2017 PRICING For all race events, price includes: o LV02 transportation, maintenance, fuel, brakes & tires o Event and Series Entry Fees For all race events, price does NOT include: o Driver’s transportation to/from racetrack o Meals during the event o Accommodation Revised: 1/4/2017 6925 Speedway Blvd C-105 Las Vegas, NV 89115 Page | 2 exrseries.com / [email protected] / O : +1(702)802-5650 INDIVIDUAL EVENT PRICING: Sprint Race Weekend Two practice sessions, two qualifying sessions and two sprint races o Homestead, Sebring, Road Atlanta, Sonoma, Laguna Seca - $11,900/driver o Las Vegas and Auto Club Speedway - $9,900/driver Endurance Race One practice session, one qualifying session and one endurance race o Las Vegas 3-hour race - $9,900/team of 2 drivers - $4,950/driver – 3 stints/driver o Las Vegas 2-hour race - $8,900/team of 2 drivers - $4,450/driver – 2 stints/driver o Utah Motorsports Park 6 hour-race - $19,900/team of 2 drivers - $9,950/driver o COTA 24-hour race - $67,600/team of 4 drivers - $16,900/driver o Thunderhill 25-hour race - $74,500/team of 5 drivers - $14,900/driver PACKAGES AVAILABLE: Sprint + Endurance Race Weekend o Las Vegas - $12,900/driver . Sprint: two practice sessions, two qualifying sessions and two sprint races . 2-hour endurance race: one qualifying session and one endurance race – 2 stints/driver o Laguna Seca - $14,900/driver . Sprint: two practice sessions, two qualifying sessions and two sprint races . 1-hour endurance race: one qualifying session and one endurance race – 1 stint/driver East EXR Sprint Series – 8 Races – 4 Race Weekends o Homestead Miami - Road Atlanta – Sebring - Las Vegas - $39,900/driver West EXR Sprint Series – 10 Races – 5 Race Weekends o Las Vegas - Laguna Seca - Sonoma - Auto Club Speedway - Las Vegas - $49,900/driver Nationwide EXR Sprint Series – 16 Races – 8 Race Weekends o Homestead Miami - Road Atlanta – Sebring - Las Vegas - Laguna Seca – Sonoma - Auto Club Speedway - Las Vegas - $79,900/driver Nationwide EXR Sprint & Endurance Series – 16 Sprint Races + 5 Endurance Races – 9 Race Weekends o Sprint Races: . Homestead Miami - Road Atlanta – Sebring - Las Vegas - Laguna Seca – Sonoma - Auto Club Speedway - Las Vegas o Endurance Races: . Las Vegas – Las Vegas - Laguna Seca – Utah or Sonoma - Las Vegas o $99,000/driver 24 Hours of COTA o $16,900/driver (4 drivers per team) 25 Hours of Thunderhill o $14,900/driver (5 drivers per team) Revised: 1/4/2017 6925 Speedway Blvd C-105 Las Vegas, NV 89115 Page | 3 exrseries.com / [email protected] / O : +1(702)802-5650 For All Events: Insurance or Damage Deposit (Mandatory: Please Select One) See Exhibit A, attached, for more details Sprint Race Event Insurance Policy Purchase: Maximum damage coverage of $25,000, with a $5,000 deductible - $990/driver (All Tracks) Endurance Race Event Insurance Policy Purchase: Maximum damage coverage of $25,000, with a $5,000 deductible - $490/driver (Las Vegas Track) - $990/driver (Other Tracks) No insurance selected by Driver - $25,000 Damage Deposit required (All Tracks) Add-ons: Race Additional Practice Session o Las Vegas (15 min) - $590 (Sprint Race) and $490 (Endurance Race) o Other tracks (20-25min) - $990/1 session - $1,790/2 sessions - $2,490/3 sessions Ride-Along (Las Vegas track only) - $199/3 laps Data & on-board video - All Tracks (including 1 analysis with comparative data overlay) - $290/weekend On-board Video/Data & Coaching (Sprint races only) - All Tracks- $590/day Coaching for Endurance Race - On Demand Copy of on-board video & Data (Endurance race) - $98/race ($49/driver) Lead-Follow session (15 min) – (Las Vegas track only) - $790/session Personal Graphics Package: 1 logo with placement on each door and hood - $290 (7-day notice required) AGREEMENT The undersigned Mr./ Mrs./ Ms. wishes to register for this program of the 2017 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. Date Name Signature Revised: 1/4/2017 6925 Speedway Blvd C-105 Las Vegas, NV 89115 Page | 4 exrseries.com / [email protected] / O : +1(702)802-5650 CREDIT CARD AUTHORIZATION Type of Card Name (as it appears on the card) Credit Card Number Expiration Date / / CVC Code Billing Address City State Zip code Country I, (full name) authorize EXR Racing Series to charge my credit card for the amount of $ dollars. Date Signature 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: 370172765 Swift Code: CINAUS6L (for international wires) BANK CHECK Payment can be done by Bank Check made payable to: Exotics Racing Series, LLC. Revised: 1/4/2017 6925 Speedway Blvd C-105 Las Vegas, NV 89115 Page | 5 exrseries.com / [email protected] / O : +1(702)802-5650 .
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