EmailMe Form - CIM Elite Athlete Application

Name: *

First Last

Gender: *

Male

Female

Email: *

Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone:

### - ### - ####

Lifetime Marathon PR Time:

Lifetime Marathon PR Date:

mm.dd.yyyy

Lifetime Marathon PR Location:

Recent Best Marathon Performance Time (from the past 3 years):

Recent Best Marathon Performance Date (from the past 3 years):

mm/dd/yyyy

Recent Best Marathon Performance Location (from the past 3 years):

Recent Best HALF Marathon Time (from the past 3 years):

Recent Best HALF Marathon Date (from the past 3 years):

mm/dd/yyyy

Recent Best HALF Marathon Location (from the past 3 years):

Optional: OTHER RACE DISTANCE BEST (within last 3 years, link to results)

Sponsor/Affiliation/Team:

Country you will be representing on race day:

Age on race day:

For travel assistance consideration, please also upload a professional running resume.

Are you currently registered for the 2022 CIM? *