This is an application to participate in the 2022 NYC Marathon as a member of The Fund for Public Health in New York City's (FPHNYC) team. Completion of this application does not guarantee a spot. You will be contacted shortly after submission of this form about approval. As a member of the team, you will be expected to fundraise a minimum of $2,620 for FPHNYC plus pay the race registration fee of $295.

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* 1. Address

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* 2. How did you hear about The Fund for Public Health in NYC (FPHNYC)?

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* 3. Why do you want to run for FPHNYC?

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* 4. Have you ever run a marathon before? If so, how many?

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* 5. Are you part of any running groups? If yes, please list below.

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* 6. Are you committed to raising or donating a minimum of $2,620 to FPHNYC by Oct 6th, 2022 plus paying the registration fee of $295 to New York Road Runners at the time of registration?

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* 7. I understand that if I do not raise the $2,620 minimum by Oct 6th, I will be charged the remaining balance on my credit card on file.  Please sign your name below.

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