Registration for Running event

Running Safari Registration
Required fields are marked with an asterisk.
Your Name*
First NameLast Name
If your group has contracted with us to create a custom Safari to meet your group's specific requirements, enter the name of your group here. Otherwise enter NA.*
Your Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Phone Number*
Area CodePhone Number
E-mail*
Gender
MaleFemale
Birth Date
MonthDayYear
Running Club (if any)
Do you plan to participate in our training runs?*
Yes, I plan to runNo, I will not be running
Please rank your running ability*

1 2 3 4 5
1 is Novice, 5 is Elite
Do you have any special dietary requests?
Contact in case of emergency?*
Phone number for emergency contact*
Area CodePhone Number
Will a companion be joining you on the Running Safari?
NoYes
Companion Name
Will you and your companion stay in the same room?
YesNo
Note: Your companion must register separately. If you elect double occupancy you and your companion will each receive an $800 discount off your registration fee.
How will you submit payment?*
CheckCredit Card

Please choose the item you wish to put on your credit card:

Non-refundable Deposit for Running Safari$500.00

Payment in Full for Running Safari$3,600.00

Payment in Full for Running Safari - Double Occupancy$2,800.00

Payment Method
Credit	Express

Running Safari Registration