REGISTER ONLINE FOR TEAM RUNNING STRONG IN THE MCM

First Name: *

Middle Initial:

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Email Address: *

Province:

Country:
Select Country: *

Daytime Phone: *

Birthdate:
Month/Day/Year *

Gender:
Male Female

Weight: *

Choose Applicable:
Wheelchair Hand-cycle Physically Impaired

Expected Finish Time: *

First Marine Corps Marathon?:
YES No

First Marathon?:
YES No

Emergency Contact's Name: *

RACE DAY EMERGENCY CONTACT INFORMATION

Emergency Contact's Phone: *

PARENT/GUARDIAN CONSENT (if under 18)

Name:

Address:

City/State/Zip:

Phone:

Will you be participating with a training group in your area?
Yes No

If yes, which one?:

Fundraising Commitment: By joining Team Running Strong and getting a guaranteed race entry, I understand that I am committing to a minimum fundraising requirement at the Billy Mills rate of $722.00 ("722" was Billy's Olympic jersey number) and that my fundraising commitment is due no later than December 31, 2012.

We encourage all charity runners to set a fundraising goal above this minimum. We'll set you up with an easy-to use online fundraising tool to make your fundraising efforts easy, effective and rewarding.

Why did you decide to run for Team Running Strong?:

Have you ever run for a charity before?
YES No

If yes, which one?:

Tribal Affiliation (if applicable):

What is your fundraising goal? *

I understand that by joining Team Running Strong, I am running on a charity team and have a responsibility to Running Strong for American Indian Youth to achieve my fundraising commitment level (not including registration) by December 31, 2012. 100% of all monies raised from Team Running Strong go directly towards program expenses for the charity Running Strong for American Indian Youth. If I have not met my fundraising commitment by December 31, 2012, Running Strong for American Indian Youth reserves the right to charge the remaining balance to my credit card. I understand that my $100 registration fee ($90 on or before May 1, 2012 and $80 for returning Team Running Strong members) and all donations processed by Running Strong for American Indian Youth are non-refundable, even if I do not participate in the 37th Annual Marine Corps Marathon on October 28, 2012 with Team Running Strong. I am at least 16 years of age.

This is an important agreement that I have read carefully. I understand and agree to the above.

Parent's acceptance of fundraising agreement (for applicants under 18):
By clicking the checkbox you agree with and are held to the fundraising agreement.

I have read and agree with the fundraising agreement

Acceptance of fundraising agreement (all runners):
By clicking the checkbox you agree with and are held to the fundraising agreement.

I have read and agree with the fundraising agreement

Acceptance of MCM Liability and Publicity Release Statement (all runners):
By clicking the checkbox you agree with and are held to the MCM Liability and Publicity Release Statement.

I have read and agree with the MCM Liability and Publicity Release Statement

Waiver of Negligence & Complete Release of Liability: Click to open the Waiver of Negligence & Complete Release of Liability in another window

Acceptance of Waiver of Negligence & Complete Release of Liability(all runners):
By clicking the checkbox you agree with and are held to the Waiver of Negligence & Complete Release of Liability.

I have read and agree with the Waiver of Negligence & Complete Release of Liability

Parent's acceptance of Waiver of Negligence & Complete Release of Liability (for applicants under 18):
By clicking the checkbox you agree with and are held to the Waiver of Negligence & Complete Release of Liability.

I have read and agree with the Waiver of Negligence & Complete Release of Liability

MCM Liability and Publicity Release Statement: Click to open the MCM Liability and Publicity Release Statement in a new window.

Parent's acceptance of MCM Liability and Publicity Release Statement (all runners):
By clicking the checkbox you agree with and are held to the MCM Liability and Publicity Release Statement.

I have read and agree with the MCM Liability and Publicity Release Statement

Confirmation of your registration will be sent to you upon receipt of your Team Running Strong registration fee. You will be taken to a page where you can access payment page upon submission of this registration form. Registration fees are not tax-deductible. Team Running Strong is filled on a first-come, first-served basis. No Federal or Marine Corps Endorsement is implied.

Please choose

I am a Returning Team Member I am a New Team Member

TEAM RUNNING STRONG REGISTRATION

CFC# 11876