Step 1 of 2: Participant Registration

After you complete and submit this screen, there is a second screen, where you will enter your registration details for this campaign.

* Required field

The Get Into Geerz Two-Day Ride 2025

Personal Information

*Email

*Mobile Phone

*First Name

Married couples: put in both first names, e.g. Yossi and Shira

*Last Name

*Gender

Male Female

*Date of Birth

-- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- 1 2 3 4 5 6 7 8 9 10 11 12

1. Select day. 2. Select month. 3. Type 4-digit year.

Fax

Website

Contact Information

Home Phone

*Mailing Address

Please be sure to use the address which appears on your credit card.

*City

*Country

-Select- Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina faso Burundi Cambodia Cameroon Canada Cape Verde Central african republic Chad Chile China Colombia Comoros Congo Democractic Republic Congo Republic Costa Rica Croatia Cuba Cyprus Czech republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino Sao Tome Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Korea South Sudan Spain Sri Lanka St Kitts St Lucia St Vincent Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Yemen Zambia Zimbabwe

*State/Province

-Select- Non-USA/Canada Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

If not applicable, select the "non-USA/Canada" option.

Zip/Postal Code

*Emergency Contact Person

*Relationship to Participant

-Select- Parent / Grandparent / Guardian Son / Daughter Husband / Wife / Fiance(e) Brother / Sister Other Relative Friend / Roommate Work Contact Mentor / Teacher / Rabbi Marathon Administrator Other

*Emergency Contact Phone

Emergency Contact Email

*Second Emergency Contact Name (if 1st unavailable)

*Second Emergency Contact Relation

*Second Emergency Contact Cellphone

Second Emergency Contact Email

Registration Information

*Currency

-Select- United States Dollars New Israeli Shekel British Pounds Canadian Dollars

Choose the currency in which you wish amounts to be displayed to you on our website. Your donors may donate in either currency.

 Please do not share my email address with 3rd parties.

*Password

Create a password to access your individualized fundraising pages.

*Confirm Password

*Short Sleeve Cycling Jersey Size (AMERICAN SIZES, NOT EUROPEAN SIZES)

-Select- XS S M L XL XXL XXXL XXXXL

Determine your jersey size here

How did you hear about us?

-Select- Referred by another rider Invited by Nachum Search Engine/Other Website Other

Specify

*I give permission to be photographed or videoed for Geerz.

Yes No

Please indicate any allergies our staff should be aware of.

Please indicate any pre-existing medical conditions our staff should be aware of.

*What is your Israeli Medical Insurance (Kupat Cholim)?

-Select- Clalit Leumit Maccabi Meuhedet N/A

If you chose N/A above, what is your traveler's insurance information? (Name & Policy Number)

Please indicate any dietary requirements our staff should be aware of.

*I require Mehadrin Kashrut

Yes No

General Comments / Questions