Summit Expeditions & Nomadic Experience
Kilimanjaro Stage Run Registration
2019 (dates TBD)
2020 (dates TBD)
Last Name / Surname
Preferred Name / Nickname
Date of Birth (Day/Month/Year)
List Any Food Allergies or Other Dietary Restrictions
List Any Drug or Other Allergies
Single room/tent at an additional cost
With (if known)
Rental Gear (optional).
All camping gear is included on the KSR, EXCEPT sleeping bag. We recommend you bring your own to get the exact comfort you need. We provide camp sleeping mattresses.
Sleeping Bag (US$30)
Describe your running program (including mileage/week)
Describe your trail running experience
For each distance, please list total number completed, PR, and event names
Other distances, times, and event names
Have you ever done multi-day stage running?
Have you ever had any running-related injuries?
List any physical limitations or medical conditions that might limit you during the Kilimanjaro Stage Run
Describe your goals/objectives for the Kilimanjaro Stage Run
Emergency Contact Information
KSR Entry Not Guaranteed
Completing this registration form does not guarantee entry into the KSR. Your registration will be reviewed by KSR Director Simon Mtuy (or his designee). You will be notified of your acceptance within two weeks.
Please read fully our
KSR TERMS & CONDITIONS
and confirm your agreement below. The Terms & Conditions includes our payment schedule and payment methods.
By checking this box, you hereby agree to be bound by the
KSR Terms & Conditions
If registrant is under 18 years of age, agreement must be checked by parent or legal guardian. Name of parent/legal guardian:
Date Required (Day/Month/Year)
We also requires a pre-trip voluntary release (waiver) form to be read and signed in Tanzania by all KSR participants (or parent/legal guardian if participant is under 18 years of age).
Two Final Questions . . .
How did you learn about the Kilimanjaro Stage Run?
Would you like to stay in touch with KSR?
Yes! Please subscribe me to the KSR newsletter (chock-full of useful info and only 2-3 times per year!)
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