PARTNERS IN THE PARKS
FIRE/ELLIS ISLAND
REGISTRATION FORM

Year Project

First Name
Last Name

Address
City
State/Province
Postal Code
Country

Phone
Email
University/college

PHYSICAL CONDITION  
Check the highest level of physcial actvity that you can comfortaby reach walking and jogging
WALKING





JOGGING





Please indicate any physical conditions or restrictions you have:
 

Respiratory
Joint problems
Back problems
High blood sugar
Low blood sugar
Seizures

 
Please indicate if you have allergies or other diet restrictions.
  Lactose intolerant
Sugar restricted
Vegetarian
Vegan
Food Allergy 		   

Describe food allergy if checked:
REGISTRATION FEE
How would you like to pay your registration fee?


Credit Card
Check