American Lung Association

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Thank you for your interest. So that we can assist you with your enquiry, please complete and submit the form below. Please note that by completing and submitting this form, you are giving us your consent to securely pass on your information to American Lung Association, and a free membership account will be created for you on our website.

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Phone number We ask for your telephone phone number as a secondary form of contact. It is not mandatory, but may prove to be helpful as part of your application. Your phone number will only be used in relation to this application and will not be passed on to third parties.

Why do you want to participate?

Fundraising target: $3500

We will consider a range of factors when allocating our places, including personal reasons for taking part and your ability to achieve our minimum fundraising target of $3,500 USD. Successful applicants will need to arrange their own travel and accommodation.

How much do you pledge to fundraise?

How will you meet your fundraising goal?

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