AbilityFirst - AbilityFirst Marathon Campaign Participant Form

Serving Children and Adults with Disabilities


By completing the process you are registering with AbilityFirst to raise funds in your name. You are not registering for participation in the Santa Anita Derby Days 5K or Los Angeles Marathon. To register for any event, please contact Stephanie Nelson at 626.243.4852. You must complete and sign an application form to enter the Santa Anita Derby Days 5K or Los Angeles Marathon.

Have you participated in the Marathon Campaign for AbilityFirst before? yes no
I plan to enter: 5K Walk Full Marathon
My company has a matching gifts program. Yes No
I am fundraising for:

FUNDRAISER'S INFORMATION:

Title:
First Name:
Last Name :
Address:
City:	State: Zip:
Day Phone Number:
Email Address:	(Note: we require the email address so that we can send a confirmation. We will not share it with any third party.)

	It is ok to send me email updates about AbilityFirst news and upcoming events.
	yes no

FUNDRAISER'S WEB PAGE LOGIN INFORMATION:
Username:	(Note: Please create a unique username with no spaces.)
Password:	(no spaces)
Re-Type Password:
Secret Question:
Answer to Secret Question:	(Note: One word answers only with no spaces. Without the secret question answer, we will not be able to assist if you forget your password.)