Shoe4Africa Runner Registration

Shoe4Africa 2017 NYC Half Marathon Application
Athlete's Name*

First NameLast Name
Gender*

MaleFemale
Shirt Size
Birth Date*

MonthDayYear
Phone Number*

Country CodeArea CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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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