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Registration Information
First Name: *
Last Name: *
Address: *
City: *
State: *
Zip / Postal: *
Country: *
Phone Number: *
Additional Phone Number:
Email Address: *
Gender: *
Male     Female
Date of Birth: *
Fundraising Commitment














Account Information
Custom URL:* Create your custom url to use for your personal fundraising page (This will also be your account username)
https://www.rayze.it/nsha/
Sign in with Google or choose a password. You will need it to view / edit your personal web page, and see who has sponsored you for this event.
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Password: *
Re-Type Password: *
Additional Information optional
Additional Comments:
How Did You Hear About Us?

Only enter this field if you were told to do so by a staff member.


NSHAHS Ambulance project is a non-profit 501c3 organization.