Run for the Memory Program
Boston's Run to Remember 2012 Team Application

Alzheimer's Association
311 Arsenal Street
Watertown, MA 02472
617.393.2047

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Red indicates required fields.

A) Application Type and Contact Information

Which distance are you interested in running? Please check one: Half Marathon 5 Mile

Last Name:

First Name:

Address:

City:

State: Zip:

Home Phone:

Cell Phone:

Employer:

Title:

Work Address:

City:

State: Zip:

Work Phone:

Fax:

Email:

B) Fundraising Experience

1) Have you participated in a marathon/road race charity program before? Yes No

If yes, for which charity and how much money did you raise. (Please list dates)

2)Have you applied to participate in a Run for the Memory event before? Yes No

If yes, indicate event and date.

3) What will your fundraising goal be for the Alzheimer's Association? (minimum donation is $1,000 for a half-marathon distance runner and $500 for a five mile distance runner) $

4) How do you plan to meet your fundraising goal?

C) Association/Disease Awareness
(Please answer the following questions so that we can get to know you a little better)

1) How did you learn about the Alzheimer's Association’s Run for the Memory program?

2) Have you had any experience with other Alzheimer's Association's programs? Yes No

If yes, how and which program?

3) Please describe why you would like to run for the Alzheimer's Association.

4) How do you see yourself becoming involved with the Alzheimer's Association after the race?

5) Volunteers are critical to the success of the Run for the Memory Program. Which events would you be interested in volunteering at in 2012?

MA State Tri (July 15, 2012) Reach the Beach Relay (May 18-19, 2012)
Sharon’s Back Triathlon (August 12, 2012)

D) Running Experience

1) Please indicate your road race experience, including recent event names, dates, distances and finish times.

2) How long have you been running and what is your average running mileage/week?

3) What is your personal time goal for Boston's Run to Remember?

4) The Alzheimer's Association will be holding monthly team meetings and group training runs on Saturday mornings. Do you foresee any conflicts in attending these meetings? Yes No

If yes, list reasons?

5) List any other fitness physical fitness activites that you are involved in.

Alzheimer's Association Term and Conditions for the 2012 Run for the Memory Marathon Training Program

Please read the following carefully before signing below.

I agree to the above terms and conditions

Name:

Emergency Contact Information

Name:

Relationship:

Phone:

Medical Information

Allergies to medications:

Thank you. Your application will be reviewed promptly.

Run for the Memory Program Boston's Run to Remember 2012 Team Application

Run for the Memory Program
Boston's Run to Remember 2012 Team Application