registration form

Registration: Adaptive Hiking/Picnic at Corn Creek, Desert National Wildlife Refuge, Clark County, NV

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Name *

First

Last

Email *

Telephone *

Total number in your party attending *

(Optional} One of our funders supports organizations that serve individuals with spinal cord injuries and they want to know the number of participants in our events that have spinal cord injuries. Do you have a spinal cord injury? *

Tell us a little about any adaptive equipment you will bring (wheelchair, walker, cane, etc.) and personal support personnel coming (family, therapists, other supporters). *

How did you hear about this event? *

Do you have a Question? *

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