NEGACDV Polar Bear Plunge Jumper Registration
Please fill out this form for each jumper. It is a $75 minimum donation per jumper to participate. All jumpers receive a Polar Bear Plunge t-shirt. You can pay your donation fee by cash, check and/or card at the event or online at www.negacdv.org. Click on the "Donate" button & please be sure to put a note with the jumper info, for example : "John Doe- Polar Bear Jumper".
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Email *
Name: *
Supporting which county? *
Number of times previously jumped with us: *
Why are you jumping this year? *
Address: *
Email Address: *
Phone Number: *
Age: *
Gender: *
T-Shirt Size: *
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