"*" indicates required fields What type of entry are you applying for? Individual Participant ($3,000) Junior Participant-25 and under ($1,500) Virtual Participant ($1,000) Registering as part of a Team ($3,000) On what date would you like to participate?* Thursday, June 6 Friday, June 7 Note: Joe Andruzzi will play on Thursday, June 6. First Name* Last Name* Address* City* State* Zip Code* Date of Birth* Cell Phone*Email Address* Employer* Title* If you selected 'registering as part of a team', please list your team members first and last names.Does your company have a matching gifts program?* Yes No Are you affiliated with the Joe Andruzzi Foundation in any way (ie: corporate member, board member, volunteer, staff, relative or friend of someone working at JAF, etc.)?* Yes No If yes, how? How did you find out about the 2024 Golf Marathon event?* Team JAF Alumni JAF E-Blast JAF Social Media JAF Website Online Search Word of Mouth Other If other, please explain: Please describe why you would like to participate for the Joe Andruzzi Foundation?*Team ApparelPlease note, athletes are asked to wear the Team JAF apparel on golf day. Please indicate men's or women's and preferred size below (S-3XL).Official Team JAF Shirt Size* Sharing your StoryIf selected, would you be willing to potentially share your story via social or traditional media outlets?* Yes No Facebook Name Twitter Handle Instagram Username FundraisingIf selected for Team JAF, what is your fundraising commitment?* $1,000 (required for Virtual Participant) $1,500 (required for Junior participant) $3,000 (required Individual Golfer Participant) $5,000 Have you participated in an athletic charity program before?* Yes No If yes, what is the most recent event and how much money did you raise? What are your ideas for raising these funds?*Golf BackgroundAre you in need of any special assistance or are you applying for participation in the disability or visually impaired division?* Yes No If yes, please explain: If selected, would this be your first golf marathon?* Yes No If no, how many golf marathons have you participated in? Do you currently belong to a golf club?* Yes No If yes, which one? Do you have any pre-existing injuries or medical conditions that may prohibit you from completing the 2024 Golf Marathon?* Yes No If yes, please explain Please provide any other information we should be aware of that might impact your ability to finish, or fundraise for the 2024 Golf Marathon?Emergency ContactName* Relationship* Home Phone*Cell Phone*Allergies/ Medications Terms & Conditions I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this application. I have read through the terms and conditions (link on the Golf Marathon web page) and acknowledge if accepted to the team, I will be required to sign a document confirming I agree to these terms and conditions. Signed* Date* MM slash DD slash YYYY
