Registration steps
	Registration fee
	Fundraising requirement
	Mid-point fundraising dates
	Cancellation Requests

There are two steps you need to do in order to participate in the Climb to Fight Breast Cancer: 1) register and 2) send in the waiver.

(Repeat climber? Click here.) Once you complete your registration form, go to Step 2. Please print out the waiver, fill in the information and mail original to: Fred Hutchinson Cancer Research Center Climb to Fight Breast Cancer Mail Stop J5-200 PO Box 19024 Seattle, WA  98109-1024 YOU WILL NOT BE CONSIDERED REGISTERED UNTIL WE RECEIVE YOUR WAIVER.

$200 registration fee for Mts Adams, Baker, Hood and Rainier
$500 registration fee for Mt Elbrus, Kilimanjaro and Volcanoes of Mexico

Registration fee is fully tax deductible* and is non-refundable, regardless of whether you surpass your fund-raising minimum. Registrations will be processed on a first come, first served basis. Space is limited, so be sure to register early. Elbrus, Rainier and Volcanos of Mexico applicants are subject to guide service approval.

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I understand that:

• As a participant of the ADAMS, BAKER or HOOD climbs, I am responsible for raising $1,500 by the April 3, 2009, mid-point and for raising a total of $3,000 by the June 3, 2009, fund-raising deadline.
  
  
• As a participant of the ELBRUS or KILIMANJARO climb, I am responsible for raising $5,000 by the February 3, 2009, mid-point and for raising a total of $10,000 by the April 3, 2009, fund-raising deadline.
  
  
• As a participant of the RAINIER climb, I am responsible for raising $2,500 by the April 3, 2009, mid-point and for raising a total of $5,000 by the June 3, 2009, fund-raising deadline.
  
  
• As a participant of the VOLCANOES OF MEXICO climb, I am responsible for raising $3,750 by the April 3, 2009, mid-point and for raising a total of $7,500 by the June 3, 2009, fund-raising deadline.
  
  

I understand that if I am unable to secure the minimum in donations by the above referenced deadlines, I will allow Fred Hutchinson Cancer Research Center to charge any balance owed on a credit card (if climber continues to fundraise after June 3, 2009 [domestic peaks] and/or April 3, 2009 [international peaks] and surpasses of his/her required minimum, charges can then be refunded accordingly). I acknowledge that I have read the Climb to Fight Breast Cancer cancellation policy on the waiver, and I accept the terms as outlined.

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Tuesday, February 3, 2009:
Mts Elbrus and Kilimanjaro

Friday, April 3, 2009:
Mts Adams, Baker, Hood, Rainier and the Volcanoes of Mexico

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Please read the Climb to Fight Breast Cancer cancellation policy. All cancellation requests must be made in writing and received in the Center’s Special Events office by date noted above by peak. Do not use e-mail. Cancellation requests should be sent to: 

Fred Hutchinson Cancer Research Center
Climb to Fight Breast Cancer
Mail Stop J5-200
PO Box 19024
Seattle, WA  98109-1024

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Print this page and mail to the address located at the bottom of this form. Don't forget to send in your waiver at the same time.

		2009 CLIMB DATES	FUND-RAISING         MINIMUM
	Mt Adams	July 17-19	$3,000
	Mt Adams	July 24-26	$3,000
	Mt Baker	July 16-18	$3,000
	Mt Baker	July 30-Aug. 1	$3,000
	Mt Baker	Aug. 13-15	$3,000
	Mt Elbrus, Russia	July 12-26	$10,000
	Mt Elbrus, Russia	July 26-Aug. 9	$10,000
	Mt Hood	June 10-11	$3,000
	Mt Hood	June 13-14	$3,000
	Mt Kilimanjaro, Tanzania	July 5-19	$10,000
	Mt Kilimanjaro, Tanzania	Aug. 2-16	$10,000
	Mt Rainier (Camp Muir)	July 5-7	$5,000
	Mt Rainier (Emmons Glacier)	July 7-10	$5,000
	Mt Rainier (Camp Muir)	July 23-25	$5,000
	Mt Rainier (Camp Muir)	Aug. 12-14	$5,000
	Mt Rainier (Camp Muir)	Aug. 22-24	$5,000
	Volcanoes of Mexico	TBA	$7,500

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Climber Signature REQUIRED

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Date REQUIRED

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Credit Card Number and Expiration Date for File REQUIRED

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Name

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Address

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City/State/Zip

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Phone Number (day)

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Phone Number (evening)

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Phone Number (cell)

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E-mail

How did you hear about the climb?
Radio 
Informational meeting 
Hutchinson Center Web site 
Friend
Google search
Alaska Airlines magazine
Backpackers magazine online
Climbing magazine
Mountaineers magazine
National Geographic Adventure magazine
Outside magazine
Washington Trails
PP&R Outdoor Recreation Guide
Quest
Seattle Times
Portland Max Mural
Climb to Fight Breast Cancer brochure
Climb to Fight Breast Cancer poster
Word-of-mouth 
Other:__________________________________________________

Enclosed is my $200 registration fee ($500 for Elbrus, Kilimanjaro and Volcanoes of Mexico).

Paying by check Please make checks payable to FHCRC and mail with registration form and signed waiver to: Fred Hutchinson Cancer Research Center Climb to Fight Breast Cancer Mail Stop J5-200 PO Box 19024 Seattle, WA  98109-1024

Paying by credit card (Visa / Mastercard / American Express / Discover) ______________________________________ Credit Card Number ______________________________________ Expiration Date ______________________________________ Name on Card

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