2012 ING NYC Marathon Application

Please review the 2012 Marathon Application and Contract thoroughly. If you feel that you can commit to the terms of our contract, complete both the application and the contract by entering all the information requested then click submit for each. Please be sure that you check the box on the contract where you accept its terms, a signature is not necessary at this time. Any omissions will cause a delay in the recruiting process.

Please enter the information asked for in the fields below. We will not process any runner's entry without all the information required being supplied.

Charity Name: The Nicholas Rossomando 9/11 Memorial Scholarship Fund
First Name:
A value is required.

Last Name:
A value is required.

**Did you apply to the 2013 ING NYC Marathon Lottery?

Entry # (if applicable)


Date of Birth:
A value is required.

Email Address:
A value is required.

Physical Address:
A value is required.

Phone #:
A value is required.

Have you ever had experience with fundraising?

We accept the credit cards listed below:

Visa, Discover, Mastercard, and American Express.
We will take your credit card number, expiration date, and CVV Number during our first contact call.
No third-party credit cards will be accepted!

Emergency Contact Name:
A value is required.

Emergency Contact Phone #:
A value is required.

Please supply your tee shirt size:

**Important: If you entered the ING NYC Marathon lottery, be sure that your name and e-mail entered above is exactly as it was entered in the lottery.