Roughing It
Registration Form

Complete this form:

Instructions

Register as an individual, or as a team. If you have any questions or need help, feel free to leave us a note using the Contact form on this website.

Thank you for helping us with your participation.

Type of registration *

Team Name

Your Name *

Your Address *

Country

City

State

Zip code

Your Phone *

Your Email Address *

Team Member Two Name

Team Member Two Address

Country

City

State

Zip code

Team Member Two Phone

Team Member Two Email Address

Team Member Three Name

Team Member Three Address

Country

City

State

Zip code

Team Member Three Phone

Team Member Three Email Address

Team Member Four Name

Team Member Four Address

Country

City

State

Zip code

Team Member Four Phone

Team Member Four Email Address

Team Member Five Name

Team Member Five Address

Country

City

State

Zip code

Team Member Five Phone

Team Member Five Email Address

Roughing ItRegistration Form