Team Challenge Registration Form

*ALL FIELDS ARE REQUIRED

*Please enter your first and last name:
*Please enter your email address:
*Please enter your cell phone number:	A value is required.
*USHPA Number	A value is required.
Paraglider Rating	P1 P2 P3 P4
*Turbulence Rating	Yes No Please make a selection.
*Limited Landing Rating	Yes No Please make a selection.
*Emergency Contact Name	Please enter the name of an emergency contact
*Emergency Contact Number	Please enter an emergency contact phone number
*Medications, Allergies or any health conditions we should know about.
To submit this form, please enter the characters you see in the image to the right:

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V.2012-5