2023 Mayhem at Monticello – Powder Creek Cowboys

2023 Mayhem at Monticello
Kansas Wild Bunch State Championship

September 2 and 3, 2023

Mayhem at Monticello Registration Form

PLEASE USE A SEPARATE ENTRY FORM AND COMPLETE A LIABILITY WAIVER FOR EACH SHOOTER.

Registering Online for this competition will incur a single $5.00 convenience fee to cover processing fees assessed by our bank for use of the credit card system. The processing fee is listed at the end of the application and will be automatically included in your total. Should you prefer to pay by check and mail your payment, you may download an application and waiver form HERE.

Entries are considered on a first-come, first-served basis and are limited to 150 total shooters.

*We reserve the right to refuse any application

Step 1 of 2

PLEASE USE A SEPARATE ENTRY FORM AND COMPLETE A LIABILITY WAIVER FOR EACH SHOOTER

Name(Required)

First Last

SASS Alias(Required)

SASS #(Required)

Phone(Required)

Email(Required)

Date of Birth(Required)

Who would you lIke to posse with?

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SASS WB Competitor Information

Gender(Required)

Male

Female

Style(Required)

Modern

Traditional

Are you over 65 and wish to be put into consideration for the Senior Age cateogry??

Yes

SENIOR (65+) (will only be used if the original category has at least 10 competitors and senior has at least 5 competitors)

Entrance Fees and Additional Meals

Please enter the quantity of the entrance fee and any additional options for the shooter below. Each Shooter will need to complete a separate registration form and Liability Waiver. For Spouse or Buckaroo Entrance fees, please enter your spouse's name or the name of the parent or guardian in the field to the right of the fee schedule.

Shooter Entrance Fee(Required)

Price:

Buckaroo Entrance Fee

Price: $0.00

Enter only the number of Children in your Family which will be entering the event, ex. if you have one child entering enter the number 1.

Parent/Guardian's name

Convenience Fee(Required)

Price:

Total

Waiver of Liability, Release, Hold Harmless and Indemnification Agreement(Required)

I have Read and Understand the Waiver of Liability

WAIVER OF LIABILITY, RELEASE, HOLD HARMLESS AND INDEMNIFICATION AGREEMENT (1.6.23)
I wish to engage in firearms shooting with Powder Creek Cowboys (“PCC”). I understand that engaging in these activities may be hazardous, with accompanying risks of personal injury, death, and/or loss or damage to me and/or my property. For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Undersigned, on my own behalf and that of my heirs, successors, representatives, administrators and assigns, hereby:
1. Waive and completely release any and all past, present or future claims, causes of action, suits, rights, damages, costs, expenses, obligations or demands of any kind whatsoever, I, or anyone on my behalf might have against PCC, its parent, affiliates, subsidiaries or successor and their respective officers, directors, members, servants, employees, agents, representatives and contractors, for any loss, damage, personal injury, death and/or loss or damage to me and/or my property resulting from my participation, spectating, observing, instruction, and consuming food and beverages during such shooting activities whether caused by the passive or active negligence of PCC or otherwise;
2. Agree to indemnify, defend and hold harmless, PCC, its parent, affiliates, subsidiaries or successor and their respective officers, directors, members, servants, employees, agents, representatives and contractors, from any and all claims by any person, firm, corporation or others, for any damages, loss or claims, of any nature, arising in any way out of my participation in such shooting activities and agrees to compensate or reimburse PCC, its parent, affiliates, subsidiaries or successor and their respective officers, directors, members, servants, employees, agents, representatives and contractors, for any cost, expense, or damages including attorney fees, filing fees and interest resulting from any claim brought against PCC for property damage, personal injury or death which arises as a result of the passive or active negligence or other act of the Undersigned while participating in and/or observing the shooting events and related activities conducted by PCC; and
3. Assume all risks associated with such activities and all responsibility for medical expenses, costs and/or other obligations and other losses or injuries to me or in which I may become involved, by reason of my participation in such shooting activities at the aforementioned facility or event.
4. I further acknowledge that I am familiar with the basic rules of firearm safety and that those basic rules have been explained to me. I agree to follow all of the basic rules of firearm safety during my use and handling of all firearms and agree to follow all of these instructions: (a) The PCC range is a “cold” range and no firearms may be loaded at any time except on the firing line and at the instruction of range officials; (b) I will treat every firearm as if it is loaded; (c) I will not place my finger on the trigger or in the trigger guard unless and until I am ready to fire or under the direction of a range officer; (d) I will always wear appropriate eye and ear protection; (e) I will never pass the firearm to anyone without opening and keeping open the cylinder or the action to verify that it is unloaded; (f) I will always follow the commands of the range officer. I understand these basic rules of firearms safety and I agree to follow them at all times.
5. Powder Creek Cowboys has an internet and social media presence. Images, including photographs, video and voice recordings are frequently used within these digital platforms as well as on printed materials promoting the club.
By signing this release, I hereby acknowledge Powder Creek Cowboys may use my image and likeness in still or motion images for promotional or educational purposes. I authorize Powder Creek Cowboys to use my image or likeness, including photographs, video, and voice recordings for the clubs promotional or educational purposes and I understand and expect I will receive no compensation or royalties for the use of my image or likeness. I release Powder Creek Cowboys from any claims that may arise from the use of my image, video, or voice recording, including but not limited to, invasion of privacy, defamation, or copyright.
6. I have read and agree to abide by the Member and Guest Code of Conduct and Rules of our club stated on our website.
7. I am over the age of eighteen (18) years of age. If I am signing on behalf of a person under the age of eighteen (18) years, then I covenant that I have the legal authority to act on behalf of such person and I bind him or her to the terms of this agreement.

I am over the age of 18 and legally allowed to enter into this contest without parental consent

Yes

No (My Parent or Legal guardian is signing for me)

Signer Name(Required)

First Last

Relationship to Shooter(Required)

Signature(Required)

Date(Required)

Credit Card(Required)

Card Details

Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

2023 Mayhem at Monticello
Kansas Wild Bunch State Championship

September 2 and 3, 2023

Mayhem at Monticello Registration Form

SASS WB Competitor Information

Entrance Fees and Additional Meals

Match Notice and Disclaimer

Visit Us

Shooting Schedule

Need More Information?

2023 Mayhem at Monticello Kansas Wild Bunch State Championship

September 2 and 3, 2023

Mayhem at Monticello Registration Form

SASS WB Competitor Information

Entrance Fees and Additional Meals

Match Notice and Disclaimer

Visit Us

Shooting Schedule

Need More Information?

2023 Mayhem at Monticello
Kansas Wild Bunch State Championship