ALS TDI: 2019 TCS NEW YORK CITY MARATHON | APPLICATION FORM

The ALS Therapy Development Institute (ALS TDI) is offering the opportunity to participate as an official entrant in the 2021 TCS New York City Marathon to be held Sunday, November 7, 2021. Before completing the application form below, it is important to note that there is a $5,000 fundraising minimum required of the successful applicant. Those funds support ALS TDI's mission to find effective treatments and cures for Amyotrophic Lateral Sclerosis (ALS).

ABOUT THE ALS THERAPY DEVELOPMENT INSTITUTE (ALS TDI)

ALS TDI is the world's foremost drug discovery center focused solely on Amyotrophic Lateral Sclerosis (ALS). As a nonprofit biotech, its Watertown, MA-based science team actively discovers and develops treatments for ALS. Led by people with ALS and drug development experts, ALS TDI understands the urgent need to slow and stop this disease. Visit www.als.net for more information.

ABOUT ALS

Amyotrophic Lateral Sclerosis, or ALS, is a disease of the nerve cells in the brain and spinal cord that control voluntary muscle movement. In people with ALS, the motor neurons deteriorate leading to muscle weakness and paralysis. Every 90 minutes, someone is diagnosed with ALS, and most people live 2-5 years after their first signs of disease. There is no effective treatment or cure.

FUNDRAISING MINIMUM

The minimum fundraising requirement is $5,000¹ and must be reached by Monday, November 8, 2021. Any outstanding balance will be charged by ALS TDI using the entrant's credit card on file on Friday, November 12, 2021.

BENEFITS OF RUNNING THE 2021 TCS NEW YORK CITY MARATHON FOR ALS TDI

ALS TDI offers the following benefits to the successful applicant:

Fundraising tips and assistance in the creation of a peer-to-peer web page for personal fundraising.
Payment of application fee to the NYRR on behalf of applicant ($255 for NYRR members; $295 for nonmembers).
Virtual 16-week training program provided by 6-Star Abbott World Marathon Majors Award recipient, Neil Gottlieb.
Branded training and race apparel.
Pre-race "carb load" dinner on Friday evening, 11/6/2021.
"Cheer" zones along race course to keep runners motivated!

APPLICATION DEADLINE

Please complete and submit this application by Wednesday, June 30, 2021 to be considered. Successful applicants will be chosen by internal selection committee, and notified no later than Friday, July 9, 2021.

¹ While $5,000 is the minimum fundraising requirement, it is our mission to develop treatments for ALS as quickly as possible, and thus we will take note of those applicants with a strategy to raise funds beyond $5,000.

Step 1 of 5

Applicant Information

First Name *

First Name is required

Middle

Last Name *

Last Name is required

Street Address *

Street Address is required

Apartment / Unit #

City *

City is required

State *

State is required

Zip Code *

Zip Code is required

Email *

Email is required Invalid Email, this field should be in the format 'user@example.com'

Phone Number *

Phone Number is required Invalid Phone Number

Gender *

Gender is required

Date of Birth *

Date of Birth is required

Employer *

Employer is required

Occupation *

Occupation is required

Step 2 of 5

Fundraising

Do you have fundraising experience? *

Yes

If yes, please describe below, in particular if you have been part of a marathon or road race charity program. Please also let us know how much you raised. *

A description of your fundraising experience is required

How much will you pledge to raise? *

$5,000

$10,000

$15,000

$20,000

Other (please specify)

A goal is required

How do you plan to reach your pledged fundraising goal? *

A description of your fundraising plan is required.

Does your employer have a Matching Gift program? *

Yes

If yes, it may be possible to double the impact of your dollars!

Step 3 of 5

Connection to the Cause

Have you, a friend, colleague or family member been personally touched by ALS? *

Yes

If yes, please provide details *

Please provide details

Why do you want to run for the ALS Therapy Development Institute? *

Your reason to run is required

Step 4 of 5

Running History

How many marathons have you run, if any? *

Number of Marathons is required

In what year did you run your most recent marathon?

In which cities have you run marathons, if any?

In what time do you expect to complete the 2021 TCS New York City Marathon? (HH:MM:SS) *

Expected Completion Time is required

Emergency Contact

Name *

Emergency Contact Name is required

Phone Number *

Emergency Contact Phone Number is required Invalid Emergency Contact Phone Number

Relationship *

Emergency Contact Relationship is required

Additional Details

Shirt Size *

Shirt Size is required

Shirt Type *

Shirt Type is required

Is there anything else you would like to share with us as we consider your application?

Step 5 of 5

Agreement and Release

I hereby guarantee that, if my application is successful, I will raise a minimum of $5,000 (minimum fundraising requirement) by Monday, November 8, 2021 for the ALS Therapy Development Institute. Should I not succeed in meeting this goal for any reason, my signature below indicates that: 1) the ALS Therapy Development Institute has my permission to charge the remaining balance to my credit card on Friday, November 12, 2021, the number of which will be provided upon notification that my application is successful and 2) I understand that the ALS Therapy Development Institute reserves the right to remove my registration from the race without refund of funds raised.
In consideration of my application, I hereby for myself, my heirs, executors and administrator, waive and release any and all rights for claims and damages I may have against the ALS Therapy Development Institute and its employees, directors, volunteers, consultants, officers and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event or travel to and from any of the preceding.
I further attest and certify that I am physically fit and a licensed medical doctor has verified my physical condition.
I verify that I have my own personal medical insurance and that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medication treatment and hospitalization.
I grant permission for use of my name, image, likeness and/or photograph in broadcast, telecast, print or any other account of this event and agree to waive any compensation for such use.

Thank You!

We appreciate your interest in running the 2021 TCS New York City Marathon. Your application has been submitted. Kindly check your email for a confirmation. We will review your information and follow up with an answer no later than Friday, July 9, 2021. If you have any further questions or comments, please feel free to contact at marathon@als.net.

2021 TCS NEW YORK CITY MARATHON APPLICATION FORM