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BoulderMax Registration
Climber's Information (please print clearly)
Name:____________________________ Age:______ Gender: M/F
Birth Date:_________ Today's Date_________
Address:_______________________________City_____________
State:________________Zip: ___________
Phone:_________________
Email:__________________
Pre Register by 5/22 $25.00 Normal Registration $30.00
Cash, Check, C.C.#:______________________Exp:_________
(payable to ClimbMax) Billing Zip:___________
– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –
STAFF USE: Date received_________
Date Rung up____________Initials____________
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