JMT Chicago Registration Form

JOIN JACK’S TEAM for the Bank of America Chicago Marathon

Fundraising Minimum:  Post-Lottery $1,500



JACK’S FUND INFORMATION AND WAIVER

Please Select One:*
 I was NOT SELECTED in the lottery. I am requesting a guaranteed race entry from Jack's Team. I did NOT ENTER the lottery. I would like to secure a guaranteed entry from Jack's Team. ALUMNI of JACK'S TEAM - I am a past member of Jack's Team or an alumni has passed on benefits, and I would like to secure a guaranteed race entry for the 2015 Bank of America Chicago Marathon. LEGACY RUNNER - I would like to join Jack's Team as a Legacy Runner.

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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