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Tanzania / Mount Kilimanjaro Fundraising Commitment and Registration Form
First Name
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Last Name
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Street Address
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Address Line 2
City
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State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
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Phone Number
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Email Address
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Police Department Associated With:
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I understand and agree that:
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1. I am responsible for fundraising at least $7,500.
2. I understand that the amount raised is non-refundable.
3. My flights to and from Tanzania are my (the traveler’s) responsibility and will not be covered by fundraising.
4. I must arrive in Arusha on or before July 14th.
5. I must work with K2 Adventures to arrange details and logistics for the trip.
6. I will attend preparation meetings prior to the trip.
7. Deposit deadline is April 1st ($1,000).
8. Full amount of $7,500 is due by May 15th.
Photo Release
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I agree to have my name and image used by K2 Adventures and Angels on Patrol.
Participant name:
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Date
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Participant signature
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