* Will the emergency contact listed above be on site during the marathon?

Yes

No

* I prefer to race in the marathon wearing a Team GLASA:

* Shirt Size

* Is this your first marathon?

Yes

No

* I am participating in the marathon as:

To understand which group you fall into and to view more details click here

* If other please explain

* I agree to reach fundraising milestones of $250 by July 1, $1,000 by September 1, and my fundraising minimum ($2,200/$2,500) by October 11.

I agree I agree

* If I do not reach these fundraising milestones, I agree to have my card charged for the required amounts at the dates listed above.

I agree I agree

* If I am injured or unable to race for any reason after completion of this application, I agree to still fundraise the required minimum for GLASA and reach each fundraising milestone

I agree I agree

* I would like GLASA to cover my marathon registration fee (value $240+).

Yes

No

* Credit Card Number (Must Be Valid Through October 2025):

* Credit Card Expiration Date:

* Credit Card CVV

* Credit Card Billing Zip Code:

* I agree to reach fundraising milestones of $250 by July 1 and $500 by September 1.

I agree I agree

* How did you hear about GLASA and why would you like to race for our mission?

* I would like to refer the following individuals to join Team GLASA and authorize you to contact them using the information I have provided below. If your friend registers, you will receive a complimentary Team GLASA branded apparel item

* I agree to the GLASA liability waiver and will sign electronically immediately upon completion of this application.

GLASA Liability Waiver

I agree I agree

* I agree to complete the necessary paperwork with the Bank of America Chicago Marathon in order to secure my guaranteed entry within 48 hours of acceptance to Team GLASA.

I agree I agree