registration form

Registration: Adaptive Hiking and Birding at Corn Creek January 28.

* Indicates required field

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? *

No-Show: If that it turns out that you cannot attend after you have registered, please let us know so that we don't wait for you.

Do you have a question for us? *

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