2026 Patriots Day Memorial Stair Climb Registration Form

Patriots Day Annual Memorial Stair Climb Registration Form

All proceeds will benefit the Jackson Fire & Rescue Community Safety Fund.
Location: The Ball Park at Jackson in Jackson TN

Date: September 10, 2026

Time: 8:00 AM

T-shirt pickup on site after September 01, 2026
Participant Details
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person

First NameLast Name
Emergency Person Phone Number

Area CodePhone Number
Relationship to Emergency Contact Person
T-shirt Size
Please choose if you will be participating in full gear or no gear.
Registration Payments

Stair Climber$35.00

Donate $22.00 extra representing 2200 steps made that day$22.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

BE SURE TO HIT SUBMIT AT THE BOTTOM TO COMPLETE TRANSACTION.
Waiver & Release
Participant's Signature
Date Signed

MonthDayYear
Date
Parent/Guardian Signature (If participant is below 18 years old)
Contact for sponsorship opportunities or questions.

LaTrell Billingsley 731.499.2145 or LBillingsley@jacksontn.gov
Should be Empty:

Patriots Day Annual Memorial Stair Climb Registration Form