Sign-Up -- Form

To participate in a Going the Distance Running and Workout program, complete the form below. You may submit it online by clicking the Submit Profile Form button, or you may print and mail it with your payment, made out to Going the Distance. Send to: Going the Distance, 81 Main Street, Peabody, MA 01960

You also may submit payments via PayPal by going to the Going the Distance Program Payments page.

Name:
Address:
City/State/Zip:
Date of Birth:
Phone Number:
E-mail address:
What is your goal for the program? If racing, what is your goal?:
What is your current long run distance?:
Race results in last 2 months. If no race results, what is a workout pace effort you want to achieve?
Weekly mileage for last month:
#Days per week you can train:
# Weekly miles you want to achieve by end of the program:
Injury Update:
Current Workout Group:
[if applicable; for example, 2 or F]
Programs and Fees:
[for more options and payment via PayPal, go to the Payments page]		 On-site Winter Outdoor Program, $100
On-site Winter Indoor Program, $139
E-mail program concurrent with on-site program, $100.
Program 2, $65/month
Payment Choice: I am paying via PalPay
I am sending a check
Signature:

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