2023 United Airlines New York City Half Marathon

United Airlines Half Marathon Form

Your Information
Name:*
First Last
Date of Birth:*
MM slash DD slash YYYY
Home Address:*
Street Address Address Line 2 City State ZIP Code
Phone:*
Email:*
Employer Information
Employer:*
Title:*
Work Address:*
City:*
Work Phone:*
Does your company have a matching gift program?*
Would your company be interested in serving as a sponsor of the Team?*
Marathon Charity Experience
Have you ever participated in a marathon charity program before?*
If so, for which charity:
How much money did you raise?*
What will be your fundraising goal for Team Life Without Lupus?*
What are your ideas for raising these funds?*
Running Experience
Are you an active runner?*
How often do you run?*
Have you ever run in a marathon before?*
Which marathons / date(s):*
What is your weekly mileage at this time?*
Are you confident that with training, you can complete a half marathon? (13.5 miles) in less than 3 hours (average of a 13.5 minute mile)?*
Health History
Do you have any medical conditions or injuries of which the coaches should be aware?*
If you have lupus, have you discussed this with your doctor?*
Allergies or Medications*
Background
How did you learn about the Lupus Research Alliance's Team Life Without Lupus?*
What is your connection to lupus (Please check all that apply).*
- I have lupus
- I have a friend or co-worker with lupus
- Child or a person with lupus
- Parent of a person with lupus
- Sibling of a person with lupus
- Other relative
- I have no connection with lupus
Please provide us with any additional information you may want us to consider while reviewing your application.*
Emergency Contact
Emergency Contact Name:*
Telephone:*
Relationship*
Terms and Condition (terms are below)
RUNNERS WHO HAVE INDEPENDENTLY RECEIVED ENTRY INTO THE 2023 UNITED AIRLINES NEW YORK CITY HALF MARATHON THROUGH LOTTERY OR NEW YORK ROAD RUNNERS QUALIFICATION

Fundraising Commitment: A $1,000 minimum donation is required to join Team Life Without Lupus. This will entitle you to all benefits of team membership which include: a team singlet, team fundraising support, Crowdrise fundraising page access, and race logistics guidance throughout the training program. A credit card (MasterCard, Visa, or American Express) in your name and valid through January 2024 must be provided upon acceptance for Team Life Without Lupus. On March 17, 2023 the credit card will be billed for any balance due to reach the fundraising minimum of $1,000, not including any application or administration fees.

Matching Gift Policy: Many companies match employees' charitable contributions. You can check with your employer to see if your company has this program, and ask your donors if their employers match gifts. Many companies issue matching gift checks quarterly or semi-annually, therefore, it is your responsibility to contact the matching company to ensure the check will be issued before March 2023. If the companies match cycle is past March 2023 the donation may not count toward your minimum.

2019 United Airlines New York City Half Marathon Registration: The Lupus Research Alliance is NOT responsible for obtaining your official race entry number; you will be responsible for following the standard procedures provided for retrieving your race number. The United Airlines New York City Half Marathon charges an Entry Fee of $130 for NYRR members, $145 for non-members. These fees do not count toward your fundraising commitment and are your responsibility to pay independently of Team Life Without Lupus.
Do you agree to the Terms and Conditions?*
Do you give consent for Lupus Research Alliance to process your personal information, including your health history?*
Submitted on:*
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