| Biking Across Kansas 2012 Registration |
If you prefer to pay by check, please fill out the form below, print it out and mail it along with payment to:
Biking Across Kansas, 103 W. 1st St., Newton, Ks 67114
Checks payable to: Biking Across Kansas
Our secure online
registration system accepts Visa and Mastercard.Your web browser preferences must be set to accept cookies in order for your registration to proceed. |
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I will
be participating
on BAK as: |
Description
of entry types |
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Lodging Preference? |
I prefer indoor sleeping space at the overnight schools if available.
(NOTE: Checking this box does not guarantee indoor lodging space every night.) |
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If
part-time rider, how many days? |
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Which
days?
(part-time riders only) |
June:
9
10
11
12
13
14
15
16
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I'm
willing to volunteer: |
As a Medic (must be qualified)
Assisting with Bike Repairs |
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Vegetarian ONLY?: |
Check here if you adhere to a vegan or vegetarian diet.
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Have
you participated
on BAK before?: |
NO, This is my first
year on BAK
YES, I have previously participated on BAK for
years.
My
first year of BAK was
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Approximate
Annual Cycling Mileage |
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Why
are you
going
on
BAK 2012? |
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Participant Information |
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Occupation: |
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T-shirt
Size: |
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I
am: |
Male
Female
Age (as of 6/9/12)
Date
of Birth MM/DD/YYYY
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First
Name: |
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Last
Name: |
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Address: |
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City: |
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State |
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Zip: |
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Country |
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Email: |
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Cell Phone #: |
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Phone: (land line) |
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If
under 18 years old, please list the name of your BAK guardian: |
(Authorized
guardians must be 25 years or older
and be a participant on BAK 2012) |
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Additional
Comments: (please list any existing medical conditions that organizers and BAK Medics should be aware of) |
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In case of emergency, please notify: |
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Name: |
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Address: |
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Primary
Phone: |
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