2023 ASICS Falmouth Road Race Application Thank you for your interest in becoming a Reach Athlete. Please allow 10-20 minutes to complete this application. At the bottom of this form, you may also save your application progress and pick up where you left off later. Falmouth Road Race Application - 2023 Division/Fundraising Level (1/8)Nonprofit Runner: $1,250 Fundraising Minimum Includes a complimentary pre-paid entry into the Falmouth Road Race. I Am Applying As A...* Nonprofit Runner Registered Runner Are you applying as a part of the Wheelchair Division?* Yes No Personal Information (2/8)Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Primary Phone*Secondary PhoneEmail* Age on Race Day (8/20/2023)*Gender* Male Female Prefer Not to Say Are you a student?* Yes No School* Area of Study* Employer* Job Title* What is your singlet size?*Every runner on our team will receive a race day singlet to represent our team. Choose OneMen’s SmallMen’s MediumMen’s LargeMen’s Extra LargeMen’s Double Extra LargeWomen’s Extra SmallWomen’s SmallWomen’s MediumWomen’s LargeWomen’s Extra LargePrior Involvement (3/8)Have you participated in a Reach Athlete event before?* Yes No Please indicate races or events you have participated in as a Reach Athlete.*Use the plus and minus buttons on the right to list as many as you see fit How did you hear about Reach Athletes and this application?*Please select all that apply. I am a current Reach Athlete Family Reach Facebook Family Reach Instagram Family Reach Twitter Family Reach Blog Family Reach Website/Events Page Word of Mouth/Current Reach Athlete Other Why Reach Athletes? (4/8)What is Your Story?*How did you learn about Family Reach & the Reach Athlete program?*Please list any affiliations you have with Family Reach.*Reach Athletes must be willing to be a team player and have a strong desire to bring awareness to the Family Reach mission. Please describe how you envision yourself as a Family Reach ambassador and what our mission means to you.*Tell us something interesting, funny, or compelling about you.*Fundraising Experience (5/8)Have You Participated in a Charity Road Race Program Before?* Yes No Please List The Races and Amount Raised*Use the plus and minus buttons on the right to list as many as you see fitRace NameAmount Raised Please List Any Other Prior Fundraising Experience*Use the plus and minus buttons on the right to list as many as you see fit. EventAmount RaisedDate The required fundraising minimum for all Family Reach runners in the New Balance Falmouth Road Race is $1,250. What is your Fundraising Goal?*What is your fundraising plan to reach that goal? Who are your potential donors?*Does your company have a corporate matching program?*Please note company matches received after the fundraising deadline will not count towards your fundraising minimum. For more information, please see our Release Form and Contribution Agreement at the bottom of this page. Yes No Which Forms of Social Media are you Active on?*Use the plus and minus buttons on the right to list as many as you see fit. If none, enter n/a into both fields.Social Media NetworkAccount URL / @ Handle At some point during the season it is encouraged that our team host a fundraising event together. Could you commit to participating and supporting a team event?* Yes No If no, please explain why below*Running Experience (6/8)Average Number of Miles You Run Per Week*Have you run the Falmouth Road Race before?* Yes No Please list the years you have run the Falmouth Road Race and your approximate finish times*Use the plus and minus buttons on the right to list as many as you see fitYearFinish Time (approx) Is this your first race of 7 Miles or longer?* Yes No Please list any other marathons you have run in the past*Use the plus and minus buttons on the right to list as many as you see fitRace NameYearFinish Time (approx) Do You Belong to a Running Club* Yes No Please List Running Clubs in Which You Are a Member*Use the plus and minus buttons on the right to list as many as you see fit Do You Have Any Pre-Existing Sports Injuries?* Yes No Please Briefly Describe Any Pre-Existing Sports Injuries*Do You Have Any Allergies or Medical Conditions* Yes No Please Briefly Explain Your Allergies or Medical Conditions*Emergency Contact (7/8)Name* First Last Phone*Relationship* Legal (8/8)Please read and agree to the Reach Athlete Release Form and Contribution Agreement HERE Consent* I have read and agree to the Reach Athlete Release Form and Contribution Agreement and verify that all information contained in this application is true and accurate.Signature* First Last Date* MM slash DD slash YYYY CAPTCHA