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US Rotax MAX Grand Nationals2014 Rotax MAX
Pan-American Challenge
Online Registration Form

Pre-registration cut-off is October 7th at 3 AM EST.
Late registrations will be accepted with an additional fee of $100.

For those that prefer to fill out a paper form and mail it in, you may download the PDF entry form here.

Competitor Information

First Name
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Last Name
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Email Address
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Telephone
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Street Address
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City
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State (or country if not U.S.)
Please provide a State or Country
Zip Code
Please enter a zip code
Date of Birth
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Class
You must select a class
Transponder #
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A current International karting license issued by an ASN affiliated to the FIA along with any other requirements of their ASN.

International License

A valid international license number is required.

FOR USA DRIVERS ONLY: Please provide your WKA membership number. If you are a US driver and do not have a WKA Membership, a temporary membership will be available to sign at registration.

WKA Membership Number
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Please provide a name and contact number(s) of your Emergency Medical Contact
Emergency Medical Contact
Please enter an Emergency Contact
Please provide a name and contact number(s) of the Parent/Guardian if competitor is under 18-years-of-age
Parent/Guardian
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Kart/Racing Information

Please provide the information about your kart, your team and where you race.

Kart Make
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Kart Model
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Team
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Kart Number

The following race number and class designation is being implemented globally for Rotax events. Micro Max 1-99, Mini Max 100-199, Junior MAX 200-299, Senior MAX 300-399, DD2 400-499, DD2 Masters 500-599, and MAX Masters 600-699.

Please select up to three choices based on your class number range and we will do our best to accommodate you. Race numbers will be allocated on a first come, first served basis.

Preferred Kart Number
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Second Choice
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Third Choice
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Event Registration

The registration fee includes:

- Entry to the 2014 Rotax MAX Pan-American Challenge at the GoPro Motorplex.
- One (1) set of tires for Micro MAX and Mini MAX OR two (2) sets of tires for Junior MAX, Senior MAX, MAX Masters, DD2 and DD2 Masters
- One (1) Bottle of XPS Oil, five (5) gallons of Fuel
- One (1) Driver Pit Pass
- One (1) Mechanic Pit Pass

Class entry fees are: Micro MAX/Mini MAX-$760, Junior MAX/Senior MAX/Masters MAX -$1005, DD2/DD2 Masters-$1,040

In addition to the standard entry items, you may add additional items that will be ready and waiting for you at the track when the event begins. Simply enter the number of extra items needed in the appropriate boxes below and they will be included in your entry transaction.

Set of Mojo D1 Tires
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$243.00
Set of Mojo D2 Tires
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$256.00
Set of Mojo D3 Tires
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$282.00
Set of Mojo W2 Tires
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$275.00
Bottle of XPS Oil
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$22.00
5 Gallons of Official Fuel
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$50.00
Set of Micro/Mini D1 Tires
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$212.00
Set of Micro/Mini W2 Tires
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$242.00

Payment Details

For those that prefer to fill out a paper form and mail it in, you may download the PDF entry form here.

Payment can be made by check if mailing the Registration Form. Checks should be made payable to RMCS.

Card Holder
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Name on Credit Card
Type of Credit Card
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MC, Visa, Disc. Card #
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American Express Card #
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CCV/CVC2 Security Code
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Security code on back of card (front of card if American Express)
Card Expiration Month
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Card Expiration Year
You must select a year
Billing Zip Code
Please provide your billing Zip Code
Billing Zip Code
 
After submitting this form, you will receive a confirmation email so you know we have received your registration.

ACCEPTANCE OF RULES AND REGULATIONS, RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT.

WARNING – READ CAREFULLY BEFORE SIGNING

This registration form must be signed by the Competitor and, if under the age of 18, by his or her parent or legal guardian (collectively “Competitor”). Upon Competitor’s completion of this registration form and payment of the registration fee, this form becomes a binding agreement between Competitor and MAXSpeed Group, Inc., including its owners, officers, directors, employees, and agents (collectively “MAXSpeed”). By signing this agreement, Competitor affirms that he or she has reviewed and is familiar with the rules and regulations (the “Regulations”) of the 2014 Pan American Challenge (the “Pan American”) that are found under the “Regulations” tab on MAXSpeed’s website located at www.GoRotax.com.

Further, Competitor agrees to comply with and to be bound by: (1) the Regulations; (2) any and all other applicable laws, ordinances, or requirements (“Other Applicable Requirements”); as well as (3) all determinations, decisions, orders, and/or directives, either oral or written, of MAXSpeed (“Directives”). These Directives may, among other things, relate to the conduct of the racing event, a Competitor’s compliance with the Regulations and Other Applicable Requirements, and the conduct of the Competitor including his or her associates, which conduct shall at all times be appropriate in all respects as determined by and in the sole discretion of MAXSpeed.

Competitor is aware that racing in all its forms including kart racing is an inherently dangerous activity and understands the risks it presents of serious bodily injury including loss of life. Notwithstanding and with the full understanding of these risks, Competitor voluntarily chooses to accept the risks and to indemnify and hold harmless MAXSpeed, and BRP-Powertrain GmbH & CO KG, (“BRP”) (MAXSpeed, and BRP including their owners, officers, directors, employees, and agents are collectively referred to for convenience only as “Promoters”) from and against any and all claims, demands, suits, judgments, attorneys' fees, medical expenses, costs, and all other expenses incurred by or assessed against Promoters arising in any way from Competitor’s participation in the Pan American. Competitor, on behalf of him or herself, his or her spouse, relatives, and all other third parties, further covenants and agrees to release from any liability whatsoever and not to sue Promoters for any injury, illness, death, loss, or damage, including both economic and noneconomic, sustained in connection with Competitor’s participation in the Grand Nationals, and agrees to pay all attorneys' fees and costs incurred by Promoters in connection with any lawsuit which Competitor brings contrary to the terms of this agreement or incurred by Promoters in connection with any lawsuit brought by any third party seeking damages against Promoters in any way connected or associated with Competitor’s participation.

COMPETITOR HAS CAREFULLY READ AND VOLUNTARILY SIGNS THIS REGISTRATION FORM INCLUDING ITS RELEASE OF CLAIMS, WAIVER OF LIABILITY AND INDEMNITY AGREEMENT WITH FULL KNOWLEDGE AND ACCEPTANCE OF ITS TERMS AND CONDITIONS.

I have read and accept the terms of this application.

Competitor's Full Name
You must enter your name here
You must signify you have read our terms and conditions by selecting "Yes".
This signifies that you have read and understand the terms of this application. Selecting "Yes" is the proxy for your signature. If you have not read or do not understand the conditions, do not select "Yes".

Parent or Legal Guardian, if competitors under the age of 18, must also enter their name and indicate that they accept the terms and conditions of this registration form.

I have read and accept the terms of this application.

Parent/Guardian Name
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This signifies that you have read and understand the terms of this application. Selecting "Yes" is the proxy for your signature. If you have not read or do not understand the conditions, do not select "Yes".
Date
Please enter today's date.
 
CAPTCHA Confirmation CAPTCHA Confirmation
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Phone:
954.251.0017

Fax:
954.251.0016

Address:
457 Goolsby Blvd., Bay #23
Deerfield Beach, FL 33442

Become a Member

Membership ApplicationBecoming a member is necessary to compete in any Rotax Max Challenge event. Become a member NOW by filling out the form available HERE

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