Join Our Boston Marathon Team - Spaulding Race for Rehab

Name:*

Title First Last

Address:*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone:*

Email:*

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Gender:*

Birthdate:*

Employer:*

Job title:*

My employer is a matching gift company:*

Entry application type:*

I’m applying to run the Boston Marathon on Monday, April 15th and need an entry.
I have a confirmed entry from the B.A.A. through a qualifying time or another source.

Please specify the source of your official number:*

I have been a member of Spaulding's Race for Rehab Team in the past:*

If so, please specify the year(s):*

I am a Spaulding employee:*

If so, please list years employed by Spaulding and site:*

I heard about Spaulding's Race for Rehab Team from:*

If being referred by a staff member, alumni or former patient, please include his/her name.

I would like to run for Spaulding because:*

Describe your personal connection to Spaulding and/or rehabilitation medicine. Please be specific in your response.

My fundraising goal is:*

$7,500
$10,000
$25,000

If selected, members of the Race for Rehab Team are required to raise a minimum of $7,500. Qualifiers and those with their own guaranteed entry have a reduced fundraising minimum of $2,500.

My proposed fundraising strategy is:*

My previous fundraising experience includes:*

Please include races, rides, walks, events, etc., total amount raised, and year(s) participated.

I am applying with a friend and/or family member:*

If so, please list the name of each friend and/or family member:*

Is this your first marathon?*

Please list the marathons (and years) you've run:*

Are you available to train locally with the Team?*

Our Team runs are typically held on Saturdays in/around Boston and along the Boston Marathon course.

Race singlet size:*

Please note, our singlets run SMALL. We encourage you to select AT LEAST ONE SIZE LARGER than you typically wear. Men’s and Women’s sizes S-XXL are available.

Shoe size:*

Emergency contact name:*

First Last

Relation to emergency contact:*

Emergency contact phone number:

I, the “Participant,” wish to participate in the 2024 Boston Marathon, being held on April 15, 2024, as a member of Spaulding Rehabilitation’s Race for Rehab Team. If accepted, I agree to raise and/or contribute a minimum of $7,500 (or $2,500 for those with their own confirmed entry) to Spaulding and will be personally responsible for the difference if I fail to collect the required funds by April 19, 2024. To secure my spot on the 2024 Race for Rehab Team, I will set up my personal fundraising page at the direction of Team Management and will provide a valid credit card with an expiration date later than May 1, 2024. Spaulding reserves the right to charge my credit card to achieve all fundraising deadlines. I also understand Spaulding has the authority to rescind my entrance to the 2024 Boston Marathon at the discretion of Team Management for misconduct and/or inadequate fundraising.

In addition to raising a minimum of $7,500 by April 19, 2024, I am responsible for covering all fees associated with the 2024 Boston Marathon, including — but not limited to — my race registration to be paid directly to the Boston Athletic Association and acknowledge this does not count towards my fundraising goal. Entries are non-transferrable and cannot be deferred to a future year. By signing below, I also agree to all terms and conditions of the Boston Marathon set forth by the Boston Athletic Association.

I agree with the above statement:*

I agree

Electronic signature:*

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Today's date:*