Adventure Chase Registration

Team Name
Have fun with it!

How did you find out about us?

Gender Choose one Male Female
T-Shirt Size Small Medium Large X-Large XX-Large
Birth Date

#2 Team Member:

Gender Choose one Male Female
T-Shirt Size Small Medium Large X-Large XX-Large
Birth Date

Address:

State Zip

City:

State Zip

Telephone Number:

Alternate Phone

Alternate Phone

Emergancy
Contact Info

Name

Number

Emergancy
Contact Info

Name

Number

Yes, send me updates?

E-mail:

Yes, send me updates?

Special Medications/Needs?

Special Medications/Needs?

Payment

$30- Advance
$35- 1 Week Out
$40- Day Of

We accept Visa, Master Card, Discover, and American Express

Choose Quantity Charge
1- $31.80 2- $63.60 3- $95.40 4- $127.20
Name on card

Credit Card Number

Expiration Date

3 Digit Sec on back

I agree to the above state charges to be immediately charged to my account. I have read and understsand the cancellation policy.
Choose YES or NO Yes, I Understand No, I need more info

Please read the Rules and FAQ's to learn all you can about the SmartAlec Adventure Chase. Before taking part in this event you will need to sign our waiver and release form. Click here to preview the form.