Survey - 2013 Run For Research Application

2013 Run For Research Application

Welcome to the 2013 Run for Research application! Please submit this form with as much detail as possible, and a staff member will be contacting you to review your application shortly after. Applications are reviewed on a rolling, first come, first serve basis. Not all applicants are accepted onto the team.

About You:

Name:

Title	First Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	State Required	ZIP Required

Country: Required

Phone Number: Required

Employer: Required

Occupation: Required

Gender: Required

Date of Birth: Required

Date of Birth:

Yes, I would like to receive e-mail from American Liver Foundation

Email Format:

Remember me. What's this?

*2.

Question - Required - What type of runner are you participating as for the 2013 Boston Marathon (R)? Charity Invitational: You are receiving your bib number from a charity
Qualified: You are fast enough to register with the Boston Athletic Association under their qualifying standards and will receive a bib number from them
Deferred/Other Runner: You acquired a bib number from the Boston Athletic Association because you decided not to start last year's marathon or you are receiving your bib number from another source.

*3.

Question - Required - How did you hear about the Run for Research Team?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - If you are a Run for Research Alum, how many years have you been involved with the Team?

(Maximum response 255 chars, approx. 5 rows of text)

*5.

Question - Required - Please describe why you want to join the Run for Research Team.

(Maximum response 255 chars, approx. 5 rows of text)

*6.

Question - Required - Do you have a special connection to liver disease? Will you be running in honor or in memory of someone?

(Maximum response 255 chars, approx. 5 rows of text)

*7.

Question - Required - Have you participated in any events supported or hosted by the American Liver Foundation? If yes, which events?

(Maximum response 255 chars, approx. 5 rows of text)

*8.

Question - Required - Have you fundraised for a charity endurance event before? If so, please describe your experience and how much you raised.

(Maximum response 255 chars, approx. 5 rows of text)

*9.

Question - Required - Please tell us about your past involvement in the community or with other charitable organizations.

(Maximum response 255 chars, approx. 5 rows of text)

*10.

Question - Required - Our Patient Match Program pairs runners with liver disease patients. Would you be interested in being a part of the program and running in honor of a patient with liver disease?

(Maximum response 255 chars, approx. 5 rows of text)

*11.

Question - Required - What is your personal fundraising goal? The fundraising commitment for Official B.A.A. Charity Runners is $4,000. The fundraising commitment for Qualified Runners or Runners who have obtained an official entry from another source is $1,000. (Please note that in addition to the fundraising minimum, there is a Run for Research Team registration fee of $150 and a B.A.A. Boston Marathon Registration Fee of $300 for Official Charity Runners. These fees are not put toward your $4,000 minimum and are non-refundable)

(Maximum response 255 chars, approx. 5 rows of text)

*12.

Question - Required - How do you plan to reach your fundraising goal? (Be Specific)

(Maximum response 255 chars, approx. 5 rows of text)

*13.

Question - Required - Does your company have a Matching Gift Program? If so, do you plan on submitting donations to be matched?

(Maximum response 255 chars, approx. 5 rows of text)

*14.

Question - Required - What prior race experience do you have? Please include information on the number of half and full marathons you have completed.

(Maximum response 255 chars, approx. 5 rows of text)

*15.

Question - Required - Do you know someone who has a number from a non-fundraising source and may be interested in joining the Run for Research Team? If so, please provide their contact information so we can tell them about the team.

(Maximum response 255 chars, approx. 5 rows of text)

*16.

Question - Required - What is your best running story (positive, inspirational, something you overcame during a run/race)

*17.

Question - Required - The fundraising commitment for Official B.A.A(R) charity runners is $4,000 due on May 15, 2013 (international runners $4,000 commitment is due February 1st). The fundraising commitment for Qualified Runners or Runners who have obtained an official entry from another source is $1,000 and is due May 15, 2013. (Please note that in addition to the fundraising minimum, there is a Run for Research Team registration fee of $150 and a B.A.A. Boston Marathon Registration Fee of $300 for Official Charity Runners. These fees are not put toward your $4,000 minimum and are non-refundable) Do you agree to the above terms?