JMT Chicago Registration Form

JACK’S FUND welcomes post-lottery and legacy runners wishing to secure an entry into the BANK of AMERICA Chicago Marathon.

Fundraising MINIMUMS: Post-Lottery $1,500

 

Please Select One:*
 PRE-LOTTERY - NEW MEMBER TO JACK'S TEAM. I would like to secure a guaranteed race entry for the 2014 Bank of America Chicago Marathon. PRE-LOTTERY - ALUMNI of JACK'S TEAM - I am a past member of Jack's Team and would like to secure a guaranteed race entry for the 2014 Bank of America Chicago Marathon. POST-LOTTERY I am/was unable to secure an entry for the 2014 Bank of America Chicago Marathon. I am requesting a guaranteed post-lottery race entry from Jack's Team.

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*:
captcha