2019 Medical Provider Data Form
Please complete this form for each individual. If you are with a group, please register each individual and provide a group name.
2019 Medical Provider Data Form
A word about volunteering
100 Mile Medic uses a mix of both paid and volunteer staff. We are happy to have you in whichever capacity you wish. If you have been trying to get into the race, working as a medical aid station volunteer gets you preferential treatment in the next year's LT100 Lottery. There is a form that you need from me stating your time as a volunteer. This form is only for you and is non-transferable.

For those that would like a little extra money for their time, we pay ALS Providers $25/hr and BLS Providers $15/hr. You work as an independent contractor and must have Colorado State Certification to be eligible for paid status.

For my ease please choose which one below.
Volunteer or Independent Contractor? *
Last Name *
Your answer
First Name *
Your answer
Email Address *
Your answer
Cell Phone Number *
Your answer
Group Name
Provide a simple group name if volunteering together.
Your answer
Medical Experience/Certification: *
Specialty, Area of Interest, etc
Examples: ICU/Trauma Nurse; Paramedic; Ski Patrol; Bike Patrol; etc.
Your answer
Race Availibity
Please carefully consider your availability. We rely upon your commitment. Last minute cancellations and "no-shows' hurt the team and endanger our racers.
Marathon and Heavy Half
Silver Rush 50 RUN
Silver Rush 50 MTB
Leadville Trail 100 MTB - Stage Race
Leadville Trail 100 - MTB
Leadville Trail 100 - RUN
This is a 30 hour race. Assignments are staggered and there are periods for rest scheduled.
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Comments and/or Questions?
Your answer
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