NYC Marathon Application 2025 Form

Signature Healthcare Brockton Hospital
2025 TCS NYC Marathon Charity Team Application

November 2, 2025

Completion of this application does not guarantee you a spot on the Signature Healthcare Brockton Hospital Team. Bibs will be awarded to 6 applicants total. A $100 application fee will be required if you are accepted onto the team. This payment will be collected at the time of acceptance as a donation on your personal fundraising page (Race Roster). Signature Healthcare will pay your $315 race registration fee to NYRR for you.

First Name

Last Name

Address

Address 2

City

State

Zip Code

Birth Date

Phone Number

Have you ever completed a marathon before?

What is your level of running experience/the furthest distance you have run?

What Is Your Connection to Signature Healthcare and Why Do You Want To Be a Part of Our Fundraising Team?

Do you have fundraising experience?

What is the most substantial amount of money you have raised for a non-profit organization?

If you are a member of our team, what will your personal fundraising goal be? Our minimum fundraising requirement is $4,000 for the 2025 NYC Marathon.

What is your plan for reaching or surpassing this goal? Please let us know some of the specific actions you will take. We will provide you support and fundraising resources along the way but we would like to see you put some thought into how you will reach your personal goal.

Who is your employer?

Do you think your company might be interested in donating to your fundraising efforts?

What is your shirt preference:?

What Size shirt would you like (Men’s/Ladies sizes available)?

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Please read the following before submitting your application:
Terms and Conditions You will receive your official race registration information after your application has been accepted on the Signature Healthcare Brockton Hospital team. All race registrations will go through the NYRR Portal and fundraising will go through our Race Roster page. Signature Healthcare Brockton Hospital will pay your race registration fee to NYRR.

Contribution
I agree to collect a minimum of $4,000.00 for the Greene Cancer Center on the campus of Signature Healthcare Brockton Hospital. If I do not reach the minimum fundraising goal required I will pay the remaining balance.

Signature

Date

Signature Healthcare Brockton Hospital 2025 TCS NYC Marathon Charity Team Application

November 2, 2025

Signature Healthcare Brockton Hospital
2025 TCS NYC Marathon Charity Team Application