2021 Stair Climb! | Arkansas Fallen Firefighters Memorial

AFFM Stair Climbing Challenge

2021 Arkansas Fallen Firefighters Memorial Stair Climbing Challenge Registration Form

Join us Saturday June 12, 2021 from 1p.m. - 4p.m. at the Hotel Hot Springs, 2nd floor lobby during the Arkansas Fire Convention in Hot Springs, AR.

Come on down to enjoy an afternoon of fun and fellowship, all to benefit the Arkansas Fallen Firefighters Memorial. There will be plenty of refreshments, and Emergency Medical Support staff will be on hand to address any medical emergencies.

If you have questions or need more information, contact Shane Dallas at (870) 261-2912.

First Name(*)

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Enter your first name.

Last Name(*)

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Enter your surname.

Mailing Address(*)

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Enter your street address

City(*)

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Enter your city

State(*)

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Select a state from the list

Zip Code(*)

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Enter your Zip Code

Mobile Phone(*)

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Email Address(*)

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Department Name

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Enter the Fire Department you wish to represent

In Honor Of

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The registration fee for the annual Arkansas Fallen Firefighters Memorial Stair Climbing Challenge is $25.00 per person.

Proceeds from this event will benefit the Arkansas Firefighter Cancer Relief Network Trust.

Waiver(*)

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I understand and agree that I must sign a Waiver of Liability before participating in this event.

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Choose Payment

Pay now through PayPal

*No PayPal account is required, you may pay with a debit or credit card.

Registration Fee(*)

25.00 - 1 person - 25.00 USD

50.00 - 2 people - 50.00 USD

75.00 - 3 people - 75.00 USD

100.00 - 4 people - 100.00 USD

125.00 - 5 people - 125.00 USD

150.00 - 6 people - 150.00 USD

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Total:

0.00 USD