Sign Up To Be a Rappeller

Registration fee is $50. Fee must be paid in order to register and goes towards your goal. You must raise a minimum of $1,000 in order to Go Over the Edge.

Your First and Last Name*

Your Email Address*

Your Goal*

Please enter a number greater than or equal to 1000.

The amount of funds you want to raise

Your Reason for Raising Funds*

Please provide a couple paragraphs describing why you are passionate about the charity and why others should also support the charity. This will be posted directly on your donation form for others to see and help them want to support you.

Your Profile Image

Accepted file types: jpg, jpeg, png, gif.

Please upload an image of your face. Must be minimum 600x600 pixels

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Event Name

Payment

Credit Card*

Card Details

Cardholder Name

Address*

Street Address Address Line 2 City State ZIP Code

Signup Fee*

Price:

I Agree*

I confirm that I have read and agree with the Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement. Please print PDF, complete, and fax or mail to our offices. I also confirm that I am at least 18 years old.

I Accept

I agree to be sent email updates leading up to the event that will help me promote my fundraising efforts.

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Name

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