Legends 100 Club Application
90 Second Website Builder
Email Completed application to:

Parvaneh Moayedi
Email:  marathonwomanp@gmail.com



City:__________________________State: ______  Zip: ___________Country:________________________

Phone #: ___________________________  Email Address:_______________________________________

How many marathons / half marathons / ultras have you run? ___________

What date did you finish your 100th marathon / ultra or Half marathon series in one calendar


Gender:   Male ______ Female ______

Birth Date________________________________

T-Shirt Size:   Small ______  Medium  ______ Large ______ X-Large ______

Signature of athlete _______________ Date _____________________________________

Signature of parent/guardian under age of 18 _________________Date________________

The applicant must be approved by a unanimous vote of the Board of Directors. All fees are none refundable after approval.
The member must pay a one-time membership fee of $100 USD. In addition, the member must pay a $20 USD annual fee.
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