2021 TCS NYC Marathon

2021 TCS NYC MARATHON

Thank you for your interest in participating in the TCS NYC Marathon on Sunday, November 7, 2021 with Team Army Ranger. Please note that all requests are on a first come basis and this does not guarantee your slot.
Name*

First NameMiddle InitialLast Name
Gender*

MaleFemale
MM/DD/YY*
Email Address*
example@example.com
Phone*
Street Address*
City*
State*
Zip*
Emergency Contact Name*
Emergency Contact Phone number*
Have you run the NYC Marathon with Army Ranger Lead The Way Fund before?

YesNo
How many times have you run the NYC Marathon?*
Adult Performance T-Shirt*

Men'sWomen'sSMLXLXXL (Men's only)
Are you currently, or have you ever, served in the 75th Ranger Regiment?*

YesNo
If yes, please provide Battalions served in and dates of service.
SECTION B: LIABILITY RELEASE & POLICY (COMPLETE ALL FIELDS)
I agree to pay my own entry fee ($255 for NYRR members/ $295 for non-members) and collect a MINIMUM of $3,000 for the Lead The Way Fund, Inc by November 15, 2021. If I have not reached the minimum in sponsorship by that date, I will be personally responsible for the balance owed and hereby grant Army Ranger Lead The Way Fund permission to charge my credit card on file.

***PLEASE NOTE: This form will only capture the first and last 4 numbers of your credit card. You will be contacted by the LTWF office to confirm your full credit card numbe. Your slot will NOT be secured until this process has been completed. ***
Billing Zip*
Army Ranger Lead The Way Fund Policy: In accepting this entry, I hereby for myself and anyone entitled to act on my behalf, waive and release any and all rights to claim for damages I may have against the Lead the Way Fund, Inc. and sponsors for all injuries suffered by me in the 2021 TCS NYC Marathon. I further attest and certify that I am physically fit and have trained for competition in this event, and a licensed medical doctor has verified my physical condition. I also agree to the fund raising agreement as stated above.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

SECTION B: LIABILITY RELEASE & POLICY (COMPLETE ALL FIELDS)