First Name

Last Name

Email Address

Phone Number

Date Of Birth

Age

Mailing Address

Place of Employment

How did you hear about the Lucky 13 Program?

Type of exercise you currently engage in

Minutes of exercise per week you currently do

Running or walking experience

Could you commit to the required workouts listed above?

What are you currently doing to achieve your health and fitness goals?

Please submit your story of how you overcame a health challenge and why you believe this is the perfect time to challenge yourself to complete your first half marathon