Register Patriot Challenge Registration 1Registration Type2Registrant Details3Additional Details How would you like to register?* Join an existing PC 2023 team As an individual Create a new team Please Select A Team*– Select One –NuStar SuperstarsRide and Run for HeroesSynovus – EPSSynovus CB&WSVeteran ERGTeam CreationTeam Name* Patriot Challenge Cause*Share with us your participation motivation! We love to hear your “why” and what motivates you to accept the Challenge. If your team is participating in the Patriot Program Incentive, please include a website and brief description of your chosen organization. To learn more about the Patriot Program Incentive, visit the “about” page above!Team Captain First Name* Team Captain Last Name* Team Captain Email* Team Captain Phone*Team Mapping (Hidden)Team Registrant DetailsFirst Name* Last Name* Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Synovus Affiliation*– Select One –VeteranMilitary Family MemberSynovus Patriot – never served, but support our militaryBranch of Service*– Select One –Air ForceArmyMarinesNavySpace ForceCoast Guard Account & PaymentCreate An Account Password* Enter Password Confirm Password Donation Frequency* No Donation One Time Monthly My Patriot Donation (optional) Enter a dollar amount you’d like to donate to the GallantFew mission. The suggested donation amount is $25.Registration OptionsParticipation ONLYRegistration + T-shirtT-shirt size*– Select One –Not Applicable / did not register to receive shirtX-SmallSmallMediumLargeExtra Large2XLCover Processing Fees? I want to cover the processing fees for my donation Coupon Code Processing Fees Price: $0.00 Total Today Select Payment Method* Credit Card (Stripe) Credit Card (PayPal) Credit Card*Card Details Cardholder Name Payment Method*PayPal Checkout American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ TweetShareSharePin0 Shares
