Registration

Username

Password

First Name

Last Name

E-Mail

Phone

Mailing address

Street

City

State

Zip

Country

Selections

Facebook

Please enter your Facebook page if you have one:

Twitter

Please enter your Twitter page if you have one:

Instagram

Please enter your Instagram page if you have one:

Google+

Please enter your Google Plus page if you have one:

Where did you hear about us?

Social Media

Word of Mouth

TV/Spectrum Ads

Other - please be specific:

Choose your area of focus

I am excited to raise funds for Easterseals Northeast Central Florida, and I have chosen to focus my fundraising efforts towards one of their many life-changing programs, which is important to me:

Autism diagnosis and specialty interventions for children and their families

Early intervention, developmental screening and life-changing therapies

Early childhood education for children of all abilities

Pediatric behavioral health and family supports

Area of greatest need

T-Shirt Size

Preferred Rappel Time

I prefer to rappel in the morning

I prefer to rappel in the afternoon

Preferred URL for personal page

Enter name or other unique identifier where the unique fundraising page will be located.

https://daytonaovertheedge.org/

Donation Goal Amount

Team

I'd like to rappel individually

I'd like to create a new Team:

I'd like to join existing Team -

Registration Fee

$0.00

Special Terms

By checking this box…
I understand and agree that:

$1,000 is the minimum fundraising necessary to rappel. Once the minimum is met, I will have secured my rappel slot. If I do not meet my minimum fundraising goal, I will have the option to cover the remaining fundraising balance by cash, credit or check the day of the event to secure a rappel slot.

Upon completing this registration form, I will be emailed a link to the WAIVER FORM.
Please fill out and sign the required Waiver
EVERYONE Going Over The Edge must complete the waiver. Once you fill out and electronically sign the form, you will be sent an email confirmation link. Then the information is sent remotely to our system. It saves paper and your time so you’ll be ready to go as soon as you arrive!

Security Question:

NO REFUNDS