{{ '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}}

{{ 'ADDRESS' | translate }}

{{ '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}}

{{ 'EMERGENCY-CONTACT' | translate }}

{{ 'NAME' | translate}}

{{ 'REQUIRED' | translate }}

{{ 'RELATIONSHIP' | translate}}

{{ 'PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

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

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

{{ 'DATA-PRIVACY' | translate}}

{{ 'EMAILS-REGARDING-REG-NO-PARAM' | translate}}

{{ eventInfo.marketingConsentQuestionText}}

{{eventInfo.marketingEmailQuestionText}}

TO THE ORGANIZER: Please accept my waiver, release from liability and agreement not to sue or seek recovery of damages for the event sponsored by Dirty Kanza Promotions LLC during the dates of Thursday, September 20, 2018 through Sunday, September 23, 2018, commonly known as Dirty Kanza Women's Training Camp, and hereinafter referred to as the “Event.” I ACKNOWLEDGE THAT BY SIGNING THIS DOCUMENT, I AM RELEASING DIRTY KANZA PROMOTIONS LLC, THE CITIES OF EMPORIA, KANSAS, MADISON, KANSAS, and EUREKA, KANSAS, THE OWNERS (WHETHER INDIVIDUALS, CORPORATIONS, PARTNERSHIPS, MUNCIPALITIES OR OTHER TYPES OF ENTITIES) OF THE PROPERTIES ON WHICH THE EVENT WILL BE HELD, ALL SERIES SPONSORS, PROMOTERS AND AFFILIATES AS WELL AS ANY AND ALL AGENTS, EMPLOYEES, CONTRACTORS, VOLUNTEERS, AND MEMBERS OF ALL SUCH ORGANIZATIONS AND ENTITIES (COLLECTIVELY "RELEASEES") FROM LIABILITY DIRECTLY OR INDIRECTLY ASSOCIATED IN ANY WAY WITH THE EVENT (INCLUDING BUT NOT LIMITED TO MY ATTENDANCE AT AND PARTICIPATION THEREIN). THIS RELEASE FORM IS A CONTRACT WITH LEGAL CONSEQUENCES. I HAVE BEEN ADVISED TO READ IT CAREFULLY BEFORE SIGNING. In consideration of the Releasees allowing me to participate in the Event, I hereby freely agree to and make the following contractual representations and agreements. I acknowledge that cycling is an inherently dangerous sport and fully realize the dangers of participating in the Event and FULLY ASSUME THE RISKS ASSOCIATED WITH SUCH PARTICIPATION INCLUDING, by way of example, and not limitation, the following: the dangers of collision with pedestrians, vehicles, other participants, and fixed or moving objects (whether before, during or after the Event); the dangers arising from surface hazards, equipment failure, inadequate safety equipment (whether before, during or after the Event), the Releasees’ own negligence, and weather conditions; and the possibility of serious physical and/or mental trauma or injury associated with athletic cycling events. FOR MYSELF, MY HEIRS, EXECUTORS, ADMINISTRATORS, LEGAL REPRESENATIVES, ASSIGNEES AND SUCCESSORS IN INTEREST (COLLECTIVELY “SUCCESSORS”) I HEREBY WAIVE, RELEASE, DISCHARGE, HOLD HARMLESS, AND PROMISE TO INDEMNIFY THE RELEASEES FROM AND AGAINST ANY AND ALL RIGHTS AND CLAIMS I HAVE OR WHICH MAY HEREAFTER ACCRUE TO ME, DIRECTLY OR INDIRECTLY, AND FROM ANY AND ALL DAMAGES WHICH I MAY SUSTAIN DIRECTLY OR INDIRECTLY IN CONNECTION WITH, ARISING OUT OF, OR IN ANY WAY RELATED TO MY PARTICIPATION IN, ASSOCIATION WITH AND TRAVEL TO AND FROM THE EVENT EVEN IF SUCH CLAIMS ARISE AS A RESULT OF THE RELEASEES’ OWN NEGLIGENCE. Further, on behalf of myself and my Successors, I agree not to sue any of the Releasees in connection with any such claims, rights or damages associated with the Event. I agree it is my sole responsibility to be familiar with the grounds, trails, roadways and venue locations where the Event may be held, the Releasee's rules, and any special regulations for the Event. I understand and agree that situations may arise during the Event which may be beyond the immediate control of the Event officials or organizers, and I must continually participate so as to neither endanger myself nor others. I accept responsibility for the condition and adequacy of my equipment that I may use in connection with the Event. I have no physical or medical condition which to my knowledge, would endanger myself or others if I participate in the Event, or would interfere with my ability to participate in the Event. I agree, for myself and my Successors, that the above representations are contractually binding, and are not mere recitals, and that should I or my Successors assert a claim in contravention of this Release, that the asserting party shall be liable for the expenses (including legal fees) incurred by the other party or parties in defending against such a claim, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence. This Release may not be modified orally, and a waiver of any provision shall not be construed as a modification of any other provision herein or as consent to any other provision herein or as consent to any subsequent waiver or modification. This Release shall be interpreted in accordance with the laws of the state of Kansas, without regard to its conflicts of laws provisions. All parties agree that any legal action arising out of or connected with the Event and this Release shall be subject to the sole and exclusive jurisdiction of the courts of the state of Kansas located in Lyon County. In addition, I hereby grant to Dirty Kanza Promotions LLC, and all legal representatives and assigns, the irrevocable and unrestricted right to use and publish photographs of me, or in which I may be included, for editorial trade, advertising, and any other purpose and in any manner and medium; and to alter the same without restriction. I hereby release these parties and all legal representatives and assigns from all claims and liability relating to said photographs. Every term and provision of this Release is intended to be severable. If any one or more of them is found to be unenforceable or invalid, that shall not affect the other terms and provisions, which shall remain binding and enforceable. 

{{ 'MUST-AGREE' | translate}}

{{ 'MUST-AGREE' | translate}}

{{ 'MUST-AGREE' | translate}}

We will do our best to accommodate most dietary restrictions and certainly food allergies.
{{'VALUE_SHORTER_THAN' | translate:'{char: "50"}' }}

{{ 'REQUIRED' | translate }}

This is not valid integer. Value needs to be between '0' and '50' Value needs to be between '0' and '50'
{{'VALUE_SHORTER_THAN' | translate:'{char: "50"}' }}

{{ 'REQUIRED' | translate }}

{{'VALUE_SHORTER_THAN' | translate:'{char: "50"}' }}

{{ 'REQUIRED' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'COUPON-APPLIED' | translate }}

{{ 'INVALID-COUPON' | translate }}

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

{{ '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}}

  • {{error}}
  • {{errValue}}
{{ 'NO-PAYMENT-REQUIRED' | translate }}
{{ 'MASTERPASS-TAGLINE' | translate }}

{{ 'MASTERPASS-HEADLINE' | translate }}

{{ 'MASTERPASS-DESCRIPTION' | translate }}


{{ 'OR' | translate }}

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

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

{{ 'CARD-NUMBER' | translate }}
{{ 'EXPIRATION' | translate }}
{{ 'SECURITY-CODE' | translate }}
{{ 'POSTAL-CODE' | 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 }} (CSC/CVC/CVV)

{{ '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