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LIVESTRONG Day 2008 Registration

Please note: If you are a 2008 LIVESTRONG Challenge, World Marathon Major (Boston, London, Berlin, Chicago, or NYC), RAGBRAI, or Grassroots Fundraising participant, please register your event but DO NOT check the box to sign up to fundraise. Instead, please use your existing fundraising account for your LIVESTRONG Day event. Thank you!

Already Registered? Click here to autofill this form
* required information
 
First Name:*
Last Name:*
Birth Date:*(mm/dd/yyyy)
Gender: Female   Male  
Email:*
Phone:*
Organization/Company Name:
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Province:
Country:
Please select the racial and ethnic category or categories with which you most closely identify. Select all that apply:* African-American/Black
American Indian/Alaska Native
Asian
Caucasian/White
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Other
I prefer not to respond
Why is raising awareness about the issues faced by cancer survivors important to you?:*
Are you a registered voter?:* Yes
No
Please briefly describe any experience you have had working/volunteering in the cancer community:*
Have you ever taken part in any of the following: Organizing events
Writing letters to elected officials or media representatives
Face-to-face meetings with elected officials
Fundraising
Speaking publicly to others about cancer issues
Public speaking about other topics
Event Name:*
Is your event open to the general public?:* Yes
No
Event Description:*
I plan to fundraise:* Yes
No
Event Location (ie: name of park, school, business, etc.):*
Event Address:*
Event City:*
Event State:*
Event Zip Code:
Event Date:*(mm/dd/yyyy)
Event Start Time:*
Event End Time:*
Event Website:
Audience for event (include anticipated number of attendees/participants):*
Describe publicity/promotional plans for this event:*
I agree to the terms defined in the waiver:* Yes
Create Username and Password
Username:*
Password:*
Verify password:*
Security Question:
Security Answer:*
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By submitting this registration form, I agree that the Lance Armstrong Foundation may post my name, email address, event location zip code, and event name and description on livestrong.org, and do not hold the Lance Armstrong Foundation liable for the distribution of this information.
        

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