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* 1. Name

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* 2. Company

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* 3. Telephone #

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* 4. Check all that apply

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* 5. Do you have any special requests?

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* 6. By checking the box you agree that if you will be on-course you understand roads are rough and 4WD is necessary.

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* 7. By checking the box you agree that you will familiarize yourself with the rules of the Garmin Dirty Kanza, and will read the Rider's Bible.

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* 8. By checking the box you agree that you will pick up your credential on Thursday, May 30th at 4pm at the Emporia Chamber of Commerce.

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