Dynomite Climbing Competition Registration

Entry Fee

Name*

First Last

Age*

Gender*

Male

Female

Phone*

Email*

Address*

Street Address City State ZIP Code

Emergency Contact Name*

First Last

Emergency Contact Phone*

Bouldering skill level*

Top Rope skill level*

What is your shirt size?*

I understand that competition shirts are only guaranteed to those who register on or before November 22nd, 2022.*

I understand

I have read and understand the Long Lines Climbing Gym's Assumption or Risk, Release, and Indemnity Agreement.*

I understand

Credit Card*

Card Details

Cardholder Name

Total

Promo Code