Choose Your Own Registration

 CHOOSE YOUR OWN RACE OR START A TEAM!

Fighting Melanoma Each Step of the Way

THESE FOUR STEPS ARE EASY! 

  1. Join Jack’s Team by completing this online form and submitting it.
  2. Individually register yourself for the marathon or half-marathon of your choice.
  3. Set up your personal fundraising page.
  4. Train!
  5. Jack’s Fund will send you a team ASICS shirt, help promote your fundraising pages through Facebook, newsletter, website, etc.

RUNNER REGISTRATION Below – JACK’S TEAM

 

* required information

Race Name:*

Race Date:*

First Name:*

Last Name:*

Suffix:

Address*:

Address 2:

City:*

State:*

Province:

Zip/Postal Code:*

Country:

Email*:

Phone*:

Birth Date (mm/dd/yy)*:

Gender:
 Male Female

Emergency Contact Name:

Emergency Contact Phone:

Emergency Contact Relationship:

Any Allergies to Medications? Please List:

Tech Shirt Style*:
 Race Singlet Short Sleeve

Tech Shirt Size*:

Fundraising Goal:
$

Why did you choose to join Jack's Team?:

Accept Waiver* (click to view waiver):
Initials: Date:

Security Image*:
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