Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Eligibility & Readiness *

I can complete basic fitness requirements (walking 5 miles, carrying 25 lbs, basic cardiovascular endurance)

yes

Agreement *

I understand the program investment begins at $100,000 per participant. I acknowledge this program includes physical, environmental, and psychological challenges. I wish to be considered for Cohort 001 and future deployments.

yes