EVENT REGISTRATION

Number of Attendees First Name Middle Name Last Name Email Phone Zip - Zip Suffix Registrant Type Family/Friend/Caregiver of: [participant name] Disability Other Disability Details Spinal Cord Injury Level C1 C2 C3 C4 C5 C6 C7 C8 T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5 S1 S2 S3 S4 S5 Mobility Other Mobility Details Birth Date / / Gender Female Male Transgender Nonbinary/Nonconforming Prefer Not to Respond Ethnicity Hispanic or Latino Not Hispanic or Latino Decline to Answer Race Participants must be able to follow directions and effectively communicate with or without assistance provided by themselves to be eligible for Adaptive Adventures programs If you have a coupon, please enter code here (case-sensitive):