Registration
* Create a Login Name:
* Login Password:
* Retype Password:
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip Code: -
* Email:
* Home Phone:
* Date of Birth (mm/dd/yyyy):
* Primary disability:
Please indicate any other disabilities (check all that apply): Amputee - lower limb
Amputee - upper limb
Cerebral palsy
Multiple sclerosis
Muscular dystrophy
Sacral agenesis
Spina bifida
Spinal cord injury - para
Spinal cord injury - quad
Stroke
Traumatic brain injury
Visually impaired / blind
Other
* Have you ever served in the armed forces?
Branch of service
* What is your involvement with Dare2tri? (Check all that apply) Athlete
Volunteer
Guide / Handler
Parent / Guardian / Relative of an athlete
Donor / Supporter
Board Member / Committee Member
Staff
Other
    
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