Survey - Team Joslin - 2023 Boston Marathon Meaning to Your Miles

127th Boston Marathon
Monday, April 17, 2023
Team Joslin Application
Meaning to Your Miles

Please note that this application is not the official Boston Marathon entry. By filling this out you are not guaranteed an entry. This application is for runners who have qualified and registered for the 2023 Boston Marathon and would like to train & fundraise with Team Joslin.

We ask that each Meaning to Your Miles applicant commit to a minimum $1,000 fundraising goal.

* = required

Personal Information


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Country:
	Employer:
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Question - Required - * Position:

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Question - Required - * Date of Birth:

Question - Not Required - Home Phone:

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Question - Required - * Cell Phone:

Question - Not Required - Work Phone:

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Question - Required - * I use the following social networks:

	Facebook
	Twitter
	LinkedIn
	Blog
	Other

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Question - Required - * T-shirt size:

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Question - Required - * Running Tank Top Size

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Question - Required - * Have you participated in a marathon/road race charity program before?

Question - Not Required - If yes, please list the charity name, event name, amount raised and year(s) participated.

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Question - Required - * Have you completed a vaccination series of a World Health Organization-certified vaccine?

The B.A.A. has announced that runners may be subject to potential proof of negative testing, potential proof of vaccination, and wearing a face mask in designated areas to participate in the 2023 Boston Marathon®.

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Question - Required - * Have you received a booster shot of a World Health Organization-certified vaccine?

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Question - Required - * Application Type:

I am B.A.A. Qualified for 2023 and have an official entry through the BAA.

Question - Not Required - Please tell us why you would like to run for Joslin Diabetes Center.

Question - Not Required - Your personal experience with Joslin (patient, friend/family member of patient, employee, etc.)

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Question - Required - * My personal fundraising goal for Team Joslin: (numeric values only)

While the required fundraising commitment is $1,000 per runner with their own entry, we encourage team members to set a goal of $3,000+ to help us raise more money and meet our team goal.

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Question - Required - * I plan to raise funds for Team Joslin through the following methods (please be specific in your plan with details on what you will do to raise funds):

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Question - Required - * My other (athletic and non-athletic) charity participation and fundraising results:

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Question - Required - * My running level:

Beginner

Intermediate

Advanced

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Question - Required - * Current weekly mileage: (numeric values only)

Question - Not Required - Typical training pace (minutes per mile): (numeric values only)

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Question - Required - * Number of previous Boston Marathons I have run: (numeric values only)

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Question - Required - * Number of previous marathons (anywhere) I have run: (numeric values only)

Question - Not Required - Training Plan:

Question - Not Required - Best marathon time/location/date:

Question - Not Required - My hobbies/interests/activities/community:

Question - Not Required - Any other information you'd like to share:

Fundraising and other requirements for accepted applicants to Team Joslin:

We ask that each Meaning to you Miles applicant commit to a minimum $1,000 fundraising goal. All Online fundraising must be done using the GivenGain fundraising platform

I assume all risks associated with my participation in this sporting event. I understand that any exercise activity may create physical stress and subsequent harmful effects and that various hazardous conditions may exist at the time of my participation. I, for myself and anyone entitled to act on my behalf, waive and release Joslin Diabetes Center and its affiliates from any liability whatsoever from any and all harm or injury that could result from my participation in this sporting event. I understand that by participating in this sporting event I am raising funds to benefit Joslin Diabetes Center. I hereby give Joslin Diabetes Center (“Joslin”) permission to use, publish, distribute, copyright and publicly display any photographic, video or audio reproductions of my photograph or voice made at or related to the above event.

I also give Joslin permission to use, distribute and publish in any format my name and any information that I have provided in the course of my participation in the above event or my being interviewed, photographed or videotaped. Joslin may also allow any commercial publication or media outlet to use my photograph, video or audio recording.

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Question - Required - * I agree to the Fundraising Agreement and Release

Yes

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Question - Required - * Participant's signature:

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Question - Required - * Date:

Month

Day

Year