Cincinnati - July 15, 2017
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This registration is:    Regular Registration
  Toss your Boss at
  Catch a Coach at
  Drop a Doc at
  Fling a Firefighter at
  Pitch a Policeman at
  Plunge your Pastor at
  Push your Principal at
E-Mail
Cell Phone Number
T-Shirt Size
Mailing Address - Street
Mailing Address - City
Mailing Address - State
Mailing Address - Zip.
Country, if not US:

Social Media

How are you listed on Facebook (Your Facebook Name)?
How is your organization listed on Facebook? (any and all)
(eg: xyz high school, xyz drama club, xyz soccer team, etc.)
Twitter handle if applicable?
Organization's Twitter handle? (any and all)
(eg: xyz business name, xyz department name, xyz club name, etc.)

Request Preferred Rappel Time

Preferred Rappel Time
Please note: we will try our best to accommodate your request, but your spot is not guaranteed until you reach the fundraising minimum.
Team Name I'd like to rappel individually

I'd like to create a new team:
I'd like to join existing team:
My Fundraising Goal:
Desired Site Name

Registration Fee
$100

Credit Card

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CVV Value:

Billing Address

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Please note: we are not able to issue refunds for registration fees or donations