Dallas 9/11 Memorial Stair Climb Registration Information

Registrations will occur individually, one at a time. There are no team registrations. See final page for additional registration details.

The following information is required when completing registration. Please utilize this document if someone is registering on your behalf.

Buyer Information

First Name:*  ______________________________________________________

Last Name:*  ______________________________________________________

Email Address:*  ___________________________________________________

Cell Phone:*  ______________________________________________________

Payment Information

Card Type:*        Visa  ∙  MasterCard  ∙  American Express  ∙  Discover

Card Number:*  ____________________________________________________

Expiration Date:*   __________________________________________________

CSC:*  ______________________________________________________________

Billing Information

Country:*  ________________________________________________________

Address:*   _____________________________________________  Address 2: _____________________________

City:*  ____________________________________________________________

State:*  ___________________________________________________________

Zip:*  _____________________________________________________________

Home Address (if different from Billing Address)

Country:*  ________________________________________________________

Address:*   _____________________________________________  Address 2: _____________________________

City:*  ____________________________________________________________

State:*  ___________________________________________________________

Zip:*  _____________________________________________________________


Work Information

Job Title (If Volunteer, list volunteer info):*  ______________________________________________________

Company/Organization (If Volunteer, list volunteer info):*   ______________________________________

Other Information

Gender:*  ▢  Male    ▢  Female

Birth Date:*  ________________________

Age:*  _____________________________

  1. Participant must agree to consult a physician prior to participation in this event*
  1. Provide an emergency contact name: *___________________________________________________
  2. Emergency contact phone number:* _____________________________________________________
  3. Emergency contact email address: ______________________________________________________
  4. Have you participated in a 9/11 memorial climb before?*
  1. Would you like to climb in memory of a specific individual or company?*
    Please note, selecting “yes” does not guarantee you will climb for this individual or company. We will do our best to accommodate your request. See our registration rules for more info.
  1. Your organization is a (Please select one)*
  1. What is your shirt size?*
  1. Do you plan to attend the Brotherhood Bash immediately after the climb?  An email with additional information will be sent in in the next few weeks.*
  1. Our event partner and sponsors make this event possible. Through their support they prove their commitment to public safety professionals. They may like to share information or products that interest you. May we provide them your email? *
  1. Would you be willing to speak with us about your experience with the Dallas 9/11 Memorial Stair Climb for use in future promotional materials?

Additional Items

You will have the option to purchase the following items prior to paying for your registration:

___ Quantity

___ Quantity

You will have 25 minutes to complete the registration. If you do not complete it in 25 minutes, your session will timeout, and you may not get another chance to complete it.

The registration may be completed on the behalf of a climber by someone other than the climber, however the answers must be answered correctly and completely. We are not responsible for inaccurate information provided to us during the registration process.

Merchandise purchased during registration will be distributed at climber check-out.

No-shows will NOT have their merchandise mailed to them. You must be present to pick items up.

Group registrations are not available.

View complete registration rules here.

A sanctioned event of the Association of Memorial Stair Climbs
PO BOX 560171 The Colony, Texas  75056
 www.dallasstairclimb.com