2019 Corporate Challenge

There are two steps to register for this event:

1. Complete the below form (includes option for payroll deduction)

2. Visit www.crouse.org/corporatechallenge to register for the event on the JP Morgan Chase website

If you attend the event and complete the course, you will only pay $15! Fee includes two free shirts and post race dinner/refreshments in the Crouse Health tent!

Question Title

* 1. Please enter your information.

First Name

Last Name

Crouse Badge #

Email address

Phone number

Question Title

* 2. Your Organization:

Crouse Hospital Employee

CMP Employee

Question Title

* 3. Have you registered on the JP Morgan Chase website for the event?

Yes, I have completed this requirement

No, and I understand I need to complete this step to participate in the walk/run

Indicate Crouse Team shirt preferences in the following questions. Shirts are moisture-wicking material. Men's shirt is a unisex fitting shirt with a crew neck, women's style is a women's cut with a v-neck. Sleeveless and short-sleeve options available. Design to be determined.

Question Title

* 4. Please indicate CROUSE HEALTH shirt selection below (JP Morgan Chase shirt selections are made separately on the race registration website):

	Select Size and Sleeve Option
.	. Select Size and Sleeve Option menu

Question Title

* 5. Payment Method:

Employee Payroll Deduction

$37 Cash or Check - Deliver to Human Resources Reception by April 26 at 4 PM NO EXCEPTIONS (check made payable to Crouse Hospital). Employees paying by check will receive $22 reimbursement if they complete the course.