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Kansas Senior Games Road Race
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Categories
Road Race -
$35.00
Race Distance
*
5K
10K
Participant Information
Contact Email
*
Participant First Name
*
Participant Last Name
*
Participant Birthdate
*
- month -
Jan
Feb
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- day -
1
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- year -
2024
2023
2022
2021
2020
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1929
1928
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1925
1924
1923
1922
1921
1920
1919
Participant Gender
*
Male
Female
Country
*
-- select country --
Canada
International
United States
Street Address (w/Apt#)
*
City
*
State
*
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select state --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Col.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-- select province --
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Zip Code
*
Phone
*
Would you like to
receive important event text alerts
on this number (eg. changes or delays)?
Emergency Contact Name
*
Emergency Phone
*
Do you want to make a donation to the Kansas Senior Games?
*
-- select one --
I want to donate - $25.00
I want to donate - $50.00
I want to donate - $100.00
I want to donate a specific amount (field will appear below)
No thanks, maybe next year
I would like to give
*
$
Hold Harmless Waiver
*
I have read and agreed to the TERMS
*
Click here to view the TERMS
.
Electronic Signature
*
Signature Date
*
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Kansas Senior Games T-Shirt
Show Product Options
S
$5
M
$5
L
$5
XL
$5
2XL
$5
3XL
$5
No Thank You
Waiver
*
I have read and agreed to the TERMS
*
Click here to view the TERMS
.
Electronic Signature
*
Signature Date
*
Is the participant 18 or older?
*
18 or older
Under 18
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian.
If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
Parent's signature
Payment Details
Discount or Tracking Code
Apply
Do not COPY & PASTE the code, please type it into this field.
Price
$
Discount (-)
$
Total
no handling
$
Processing
$
Donation
$
Total Owed
$
Payment Method
The payment and credit card section is not visible because there is nothing owed or form fields have not been fully completed.
Visa/Mastercard
Payable To:
Address:
click the "submit" button to submit your order then send a check to (or pay in person at) the address above.
1. Venmo the total amount to the Phone #:
2. Make sure you enter the code,
58743
in "What's it for".
3. Click the "pay now" button.
Enter a Check Number
Enter a Check Amount
Send email receipt to the participant
Purchase
Purchase
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