2019 Cholocate Challenge - 10K Run/5K Walk/Run

Crouse/CMP Employee Authorization for Payroll Deduction

Register to walk or run the Chocolate Challenge, held on Saturday, July 27, 2019 at Sharkey's Liverpool.

There are two steps to register for this event:

1. Register on the Chocolate Challenge website, enter coupon code "TEAMCROUSE" (waives payment requirement on this site). Payment will be coordinated through Crouse and in Step #2 below.

2. Complete this form to authorize payroll deduction.

Participants will receive a Team Crouse Chocolate Challenge t-shirt, post-race lunch, refreshments and access to the post race party.

Question Title

* 1. Please enter your information.

First Name

Last Name

Crouse/CMP Badge #

Email address

Phone number

Question Title

* 2. Your Organization:

Crouse Hospital Employee

CMP Employee

Question Title

* 3. Have you registered on the Chocolate Challenge website for the event?

Yes, I have completed this requirement

No, and I understand I need to complete this step to participate in the walk/run. Please register now before proceeding: https://chocolatechallenge.org/. Use coupon code "TEAMCROUSE" to bypass payment on registration site.

Question Title

* 4. Amount authorized to payroll deduct:

(Note: Final payment will range from $15-$30 and will include Team Crouse Chocolate Challenge shirt. (If you do not complete the race, you will be charged the full cost of the event registration.)

Number of participants registered for specific race
Wags for Swag - $20
Wags for Swag - $20 Number of participants registered for specific race menu
5K Walk - $25
5K Walk - $25 Number of participants registered for specific race menu
5K Run - $25
5K Run - $25 Number of participants registered for specific race menu
10K Run - $40
10K Run - $40 Number of participants registered for specific race menu
10K Virtual Run - $40
10K Virtual Run - $40 Number of participants registered for specific race menu

Question Title

* 1. Please enter your information.

Question Title

* 2. Your Organization:

Question Title

* 3. Have you registered on the Chocolate Challenge website for the event?

Question Title

* 4. Amount authorized to payroll deduct: (Note: Final payment will range from $15-$30 and will include Team Crouse Chocolate Challenge shirt. (If you do not complete the race, you will be charged the full cost of the event registration.)

Question Title

* 5. Please enter the total cost for all the particpants you have registered. (number of participants x the cost of race selection)

* 4. Amount authorized to payroll deduct:

(Note: Final payment will range from $15-$30 and will include Team Crouse Chocolate Challenge shirt. (If you do not complete the race, you will be charged the full cost of the event registration.)