{{ 'SHOW_CART' | translate }} >

{{total | currency:"$"}}

{{::eventInfo.eventName}}

{{::eventInfo.when}}
{{::eventInfo.where}}

{{::eventInfo.description}}

{{ 'COUPON-APPLIED' | translate }}

{{ 'INVALID-SECONDARY-COUPON' | translate }}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'FIRST-NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'IDENT.NAME_CHARS_LONG' | translate}}

{{ 'LAST-NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'IDENT.NAME_CHARS_LONG' | translate}}

{{ 'BIRTH-DATE' | translate}}

{{ 'IDENT.RACE_AGE_BETWEEN' | translate:regOptionAgeTranslate }}

{{ 'IDENT.SERIES_RACE_AGE_ERROR' | translate }}

{{ 'REQUIRED' | translate }}

{{'REQUIRED_DATE_FORMAT' | translate:'{format: eventInfo.displayDateFormat}' }}

{{ 'GENDER' | translate}}

{{ 'REG-OPTION-GENDER-ERROR' | translate}}

{{ 'PRIMARY-PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'NOT-VALID-PHONE-NUMBER' | translate}}

{{ 'EMAIL' | translate}}

{{ 'EMAIL-CONFIRM' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'SAME-EMAIL' | translate}}

{{ 'PARTICIPANT-CONDITION' | translate}}

The Fireweed 400 Inc. Entry, Accident Waiver and Release of Liability 2018 
 
I acknowledge that this athletic event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by terrain, lack of hydration, wild animals, domestic animals, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including but not limited to participants, volunteers, spectators, coaches, event officials, event monitors, and/or producers of the event. These risks are not only inherent to athletics, but are also present for volunteers and support crews. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or of their possible liability without fault. 
 
I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person. 
 
I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and responsibilities at said events. 
 
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: American Bicycle Racing, Inc., The Fireweed 400 Inc., Race Across America, the UltraCycling Marathon Association, their directors, officers, employees, volunteers, representatives, committee members, members, and agents, the event holders, event sponsors, event directors, event volunteers; and any other party, municipalities or other public entities connected with this event; (B) indemnify and Hold Harmless the entities of persons mentioned in this paragraph from any and all liabilities or claims made my other individuals or entities as a result of any of my actions during this event, arising out of my travels to or returning from this event.  
  
I hereby consent to receive medical treatment, which may be deemed advisable in the event of injury, accident and/or illness during this event. I understand that at this event or related activities, I may be photographed or filmed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and or assigns. 
 
This ARWL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document and that I understand its content. 
 
Parent/Guardian Waiver for Minors (under 18 years old) 
 
The undersigned parent and natural guardian or legal guardian does here by represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred to above for all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.

{{ 'MUST-AGREE' | translate}}

{{ 'TEAM-DESC-HEADER' | translate}}
  • {{ 'TEAM-DESC-SELECT' | translate}}
  • {{ 'TEAM-DESC-OTHERWISE' | translate}}
  • {{ 'TEAM-DESC-INDIVIDUAL' | translate}}



{{ 'TEAM-JOIN-DESCRIPTION' | translate}}

{{ 'TEAM-JOIN-SELECTED' | translate:entry }}

{{ 'TEAM_BRACKET_TEAM.FULL' | translate }}

{{ 'TEAM_BRACKET_TEAM.TOO_YOUNG' | translate }}

{{ 'TEAM_BRACKET_TEAM.TOO_OLD' | translate }}

{{ 'TEAM_BRACKET_TEAM.WRONG_GENDER' | translate }}

{{ 'TEAM_BRACKET_TEAM.TOO_MANY' | translate }}

{{ 'TEAM_BRACKET_BRACKET.PREPAID_LARGER' | translate:entry }}

{{ 'TEAM_BRACKET_TEAM.ERROR' | translate }}

{{'AS-TEAM-CAPTAIN' | translate}}
{{'SELECT-WHO-PAYS' | translate}}

{{ 'AS-TEAM-CAPTAIN' | translate }}

{{'TEAM-SELECT-BRACKET-INFO' | translate}}

{{ 'TEAM_BRACKET_BRACKET.TOO_YOUNG' | translate }}

{{ 'TEAM_BRACKET_BRACKET.TOO_OLD' | translate }}

{{ 'TEAM_BRACKET_BRACKET.WRONG_GENDER' | translate }}

{{ 'TEAM_BRACKET_BRACKET.TOO_MANY' | translate }}

{{ 'TEAM_BRACKET_BRACKET.PREPAID_LARGER' | translate:entry }}

{{ 'TEAM_BRACKET_BRACKET.ERROR' | translate }}

{{'AGE' | translate}}: {{'AGE-ANY' | translate}} {{'AGE-OR-OLDER' | translate:tbr}} {{'AGE-OR-YOUNGER' | translate:tbr}} {{'AGE-RANGE' | translate:tbr}}
{{'GENDER' | translate}}: {{tbr.sex || 'MIXED' | translate}}
{{'MEMBERS' | translate}}: {{tbr.min_members || 0}} - {{tbr.max_members || 'Unlimited'}}

{{ 'COUNTRY' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STREET' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STREET_2' | translate}}

{{ 'POSTAL-CODE' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}} {{ 'VALID-ZIP' | translate}}

{{ 'CITY' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STATE/REGION' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'RELATIONSHIP' | translate}}

{{ 'PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'NOT-VALID-PHONE-NUMBER' | translate}}

{{ 'CONTACT-CANNOT-BE-EVENT-P' | translate}}

{{ 'COUPON-APPLIED' | translate }}

{{ 'INVALID-COUPON' | translate }}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'PAYMENT-ERROR' | translate}}

{{paymentErrors.message}}

  • {{errValue}}

{{ 'CORRECT_ERRORS_FOR_ENTRY' | translate }}

{{ 'COMPLETE_REGISTRATION_FOR_ENTRIES' | translate}}

{{entry.name | translateIf:entry.translate}}

{{ 'EDIT' | translate }} (errors)

{{item.name | translateIf:item.translate}} :

{{item.price | currency:"$":currency.decimal}}
{{ 'SUBTOTAL' | translate}} : {{cart.subtotal | currency:"$":currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$":currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.fee | currency:"$":currency.decimal}}
{{!cart.hasLottery ? ('TOTAL'|translate) : ('TOTAL_CHARGE_AT_CHECKOUT'|translate)}} : {{cart.total | currency:"$": currency.decimal}}

{{item.name | translateIf:item.translate}} :

{{item.price | currency:"$":currency.decimal}}
{{ 'SUBTOTAL' | translate}} : {{cart.subtotalLottery | currency:"$": currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$": currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.lotteryFee | currency:"$": currency.decimal}}
{{ 'TOTAL_CHARGE_IF_SELECTED' | translate}} : {{cart.lotteryTotal | currency:"$": currency.decimal}}
{{ 'IF_SELECTED_CHECKOUT' | translate:cart}}

{{ 'PAYMENT-ERROR' | translate}}

{{paymentErrors.message}}

  • {{errValue}}
{{ 'NO-PAYMENT-REQUIRED' | translate }}

{{ 'NAME-ON-CARD' | translate }}

{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}
{{ 'EXPIRATION' | translate }}
{{ 'SECURITY-CODE' | translate }}
{{ 'POSTAL-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'NAME-ON-CARD' | translate }}

{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-CREDIT-CARD-NUMBER' | translate }}

{{ 'EXPIRATION' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-EXPIRATION-DATE' | translate }}

{{ 'SECURITY-CODE' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-SECURITY-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'PAYMENT-INFORMATION-MESSAGE' | translate }}



{{crowdriseTeam.entryName}} Charity Event Fundraising on Crowdrise

{{crowdriseTeam.entryName}}: {{crowdriseTeam.msg}} (Crowdrise error)

The internet browser you are using to access this registration form is not supported. Please upgrade your browser or register on your mobile device.
Scan this QR Code with your mobile device to load the mobile registration form.
Event registration link