Shoe4Africa Runner Registration

Shoe4Africa 2017 NYC Half Marathon Application
Athlete's Name *

First Name Last Name
Gender *

Male Female
Shirt Size
Birth Date *

Month Day Year
Phone Number *

- Country Code - Area Code Phone Number
E-mail *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Donation Goals
If accepted by Shoe4Africa, I commit to raising at least $1,000 as follows:

$250 raised by 1 February 2017

$1000 raised by 11 March 2017

I understand that my participation in the United Airlines NYC Half Marathon is contingent on meeting the $1,000 minimum fundraising goal as per NYRR Charity Partner Guidelines. I also understand that I am responsible for paying the race registration fees to the NYRR.

By submitting this form, I am agreeing to the donation conditions and liability waiver. I am doing so by means of an electronic signature that will have the same effect as an original manual paper signature and be equally binding.
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