| First Name * First Name |
|
| Last Name * Last Name |
|
| Address Line 1 * Address Line 1 |
|
| Address Line 2 Address Line 2 |
|
| City * City |
|
| State/Province * State/Province |
|
| Zip Code/Postal Code * Zip Code/Postal Code |
|
| DayPhone * DayPhone |
|
| Is this your * Is this your |
Home |
|
Work |
|
Cell |
| Evening Phone Evening Phone |
|
| Is this your Is this your |
Home |
|
Work |
|
Cell |
| EMail * EMail |
|
| How would you like to be contacted? How would you like to be contacted? |
Email |
|
Day Phone |
|
Evening Phone |
| Gender Gender |
|
| I am interested in the following sport * I am interested in the following sport |
|
| Select an information meeting to attend
|
Meetings Available in your Area:
| Tue,12-01-09, 6:00PM Cedar Rapids Info Meeting Mr. Bean's 1080 E. Post Rd. Marion,IA,
|
| Tue,12-01-09, 6:00PM Ankeny Info Meeting DMACC, Building 6, Room 12 2006 S. Ankeny Blvd. Ankeny,IA,
|
| Wed,12-02-09, 6:00AM Urbandale Info Meeting Urbandale Public Library 3520 86th St. Urbandale,IA,
|
| Thu,12-03-09, 6:00PM West Des Moines Info Meeting West Des Moines Learning Resource Center 3550 Mills Civic Parkway West Des Moines,IA,
|
| Thu,12-03-09, 6:00PM Iowa City Info Meeting Iowa City Public Library, Meeting Room D 123 S. Linn St. Iowa City,IA,52240
|
| Mon,12-07-09, 6:00AM Des Moines Info Meeting Des Moines Public Library 1000 Grand Ave. Des Moines,IA,
|
| Mon,12-07-09, 6:00PM Coralville Info Meeting Coralville Public Library, Meeting Room 1401 Fifth St. Coralville,IA,
|
| Tue,12-08-09, 6:00PM Ames Info Meeting Ames Public Library 515 Douglas Ave. Ames,IA,
|
| Tue,12-08-09, 6:00PM Quad Cities Info Meeting Mississippi Regional Blood Center 5500 Lakeview Parkway Davenport,IA,
|
| Tue,12-15-09, 6:00PM Eastern Iowa Info Meeting & Kick Off Pizza Ranch 395 Beave Kreek Ctr., Unit C North Liberty,IA,
|
| Thu,12-17-09, 6:00PM Des Moines Info Meeting & Kick Off Quality Inn & Suites 929 3rd St. Des Moines,IA,
|
|
|
|
| Select an event you are interested in Select an event you are interested in |
|
| Are you planning on Bringing a friend? Are you planning on Bringing a friend? |
|
| If yes, what is your friend's name? If yes, what is your friend's name? |
|
If you received a mailing about Team In Training, please provide us with the following information from the mailing label:  |
| Participant Code (found in top left corner of mailing label) Participant Code (found in top left corner of mailing label) |
|
| Source Code (found in top right corner of mailing label) Source Code (found in top right corner of mailing label) |
|
| Are you a TNT Alumnus? Are you a TNT Alumnus? |
|
| What was the primary way you heard about Team In Training? * What was the primary way you heard about Team In Training? |
|
| If you heard about Team In Training through one of our corporate sponsors or partners, which company was it? |
|
| I am an employee of this company's national team I am an employee of this company's national team |
|
| I would like to receive advocacy email updates to learn how else I can assist in the fight to cure blood cancers. I would like to receive advocacy email updates to learn how else I can assist in the fight to cure blood cancers. |
Yes |
|
No |
| I am interested in starting a Friends/Family/Corporate Team. I am interested in starting a Friends/Family/Corporate Team. |
|
| Comments |
|
| The Society respects your privacy |