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Email address *

Password *

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Personal details

Title *

First Name *

Last Name *

Email address *

Password*

Mobile *

Date of birth *

Gender *

Male Female Other

Dietary requirements

Shirt size *

Postal address *

(enter address manually)

Address Line 1 *

Address Line 2 (opt)

City *

Postal Code *

State *

Country *

Emergency Contact Details

Please provide us with an emergency contact

First Name *

Last Name *

Contact Number *

Relationship to you

Medical conditions

Do you have any pre-existing medical conditions which might affect your ability to take part, or be relevant if treatment is needed?

Yes No

Please provide details

What is your relationship to The Ability Experience? *

Undergraduate Member of Pi Kappa Phi
Alumni Member of Pi Kappa Phi
Pi Alpha
Friend of The Ability Experience

How did you hear about the event? *

What size cycling jersey do you wear?

What size cycling bibs/shorts do you wear?

Who is your preferred roommate during the event?

Will you plan on attending the 50th Anniversary Celebration Dinner on Saturday night? (it is included with your fundraising) *

Yes
No
Not sure right now

Will you need a hotel room in DC on Saturday night? (it is included with your fundraising) *

Yes
No, I will need to leave Saturday after Arrival
Not sure of my plans yet

The Ability Experience is the philanthropic initiative of Pi Kappa Phi.

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