* 1. What is your first name?

* 2. What is your last name?

* 3. At what email address would you like to be contacted?

* 4. What is your street address?

* 5. What is your preferred phone number?

* 6. What is your gender?

* 7. What is your date of birth?


* 8. Who is your employer?

* 9. Does your company have an employee matching gifts program?

* 10. Did you apply to gain entry to the Marathon on your own this year?

* 11. Are you applying to the Liver Life Challenge team as a participant or a supporter?

* 12. All accepted applicants to the team will receive a link to register online and must be prepared to pay $100.00 non-refundable donation to confirm registration. Are you prepared to make this donation, if accepted?

* 13. Please provide us with your T-shirt size. The training T-shirts are dri-mesh and unisex.

* 14. Have you ever raised funds for a charity organization through an endurance event?

* 15. If so, for which event and which charity? How much did you raise? (Please be specific)

* 16. If accepted to the Liver Life Challenge team, what will your fundraising goal be? There is a fundraising minimum of $3,000 for the TCS NYC Marathon. Raise $7,500 and become a Top Fundraiser to receive extra perks and prizes.

* 17. What are your ideas for raising these funds? Please be as specific as possible.

* 18. Are you an active runner?

* 19. Are you confident that with training you can complete a marathon in less than 6 hours?

* 20. Please list any previous involvement with the American Liver Foundation.

* 21. What is your connection to Liver Disease?

* 22. Please share your story with us. Why do you want to run with the Liver Life Challenge team and how did you choose us as your charity of choice? Provided information will not be viewed or printed outside of staff members reviewing applications. (Please be specific as possible. The Liver Life Challenge program is competitive, and detailed information will help us when reviewing applications.)

* 23. Please provide us with any additional information you may want us to consider while reviewing your application.