Climb For A Cure Online Registration

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Registrant #1

Who are you registering? *

First Name *

Last Name *

Email Address *

Confirm Email *

Create Password *

This will be the password for your BikeSignup account.

Confirm Password *

Date of Birth *

Format: mm/dd/yyyy

Used for age group calculations

Gender *

Male Female

Phone *

Valid formats include: 000-000-0000 or 0000000000

Street Address *

Country *

Zip Code *

City *

State *

Choose Your Event *

Adult Participant

Open to ages 13+.

$20.00 + $2.20 SignUp Fee

(Group Pricing)

Kid Participant

Open to ages 12 and under.

$5.00 + $1.30 SignUp Fee

(Group Pricing)

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Climb For A Cure

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Registrant #1

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