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{{ 'FIRST-NAME' | translate}}

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{{ 'EMAIL' | translate}}

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{{ 'ADDRESS' | translate }}

{{ 'COUNTRY' | translate}}

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{{ 'DATA-PRIVACY' | translate}}

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In consideration of your accepting this entry form, I, the undersigned, intending to be legally bound for myself, my heirs, executors and administrators, waive and release any and all rights and claims for damages I may have against Blackbox International, the officials and sponsors of the Made New 5K, whether caused by my negligence or that of Blackbox International or the officials, sponsors or volunteers working such Run.  I acknowledge that I am aware of the inherent risks of participation in an athletic event of this type. I assume all risk of injury, whether or not caused by negligence, and release any claim I may have for any injury that I may sustain.  I irrevocable grant full permission to Blackbox International to use photographs, videotapes, motion pictures and/or recordings of me, or any other record of this event for any legitimate purpose.

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{{ 'MUST-AGREE' | translate}}

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Please fill out the Victory Ministries Waiver and Release Form: https://victoryjoplin.com/waiver

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{{ '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}} :

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{{ '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}}

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

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

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