Morgan Memorial Goodwill Industries Running for Great Kids 2019 Boston Marathon Team Application

Transcription

1 1 Morgan Memorial Goodwill Industries Running for Great Kids 2019 Boston Marathon Team Application Applications will be accepted on a rolling basis, our team will be announced on November 8, Send completed applications to: Nicole Caouette Events Manager, Development Morgan Memorial Goodwill Industries 1010 Harrison Ave. Boston, MA ncaouette@goodwillmass.org Phone: Fax: Personal Information: Last Name First Name Home Address City State Zip Date of Birth Preferred Address Preferred Phone Number Employer Job Title Work Address City State Zip Alternative Phone Number

2 2 Application Type: I am applying for a bib to run and fundraise on behalf of Morgan Memorial Goodwill Industries as a member of Running for Great Kids. The fundraising minimum for the 2019 Boston Marathon as part of Goodwill s Running for Great Kids Program is $7,500. I have already secured an official entry from the B.A.A. and would like to run and fundraise on behalf of Morgan Memorial Goodwill Industries Running for Great Kids. The fundraising minimum for the 2019 Boston Marathon as part of Goodwill s Running for Great Kids Program is $1,500. Note: Runners are responsible for paying their entry fee directly to the B.A.A. My Motivation: How did you hear about the team? I would like to run and raise money for Running for Great Kids because (include additional pages, if needed): Are you affiliated with Goodwill: event participant, sponsor, volunteer, staff, relative or friend of someone working at Morgan Memorial Goodwill Industries, etc.?

3 3 Fundraising: My minimum fundraising commitment (minimum required is $7,500): $ While the required fundraising minimum to be part of the Running for Great Kids Team is $7,500 per runner, we encourage team members to set a higher personal goal. Aim high and you will be amazed at what you can achieve! What is your fundraising goal? My fundraising goal: $ Does your company plan to support your fundraising efforts? (Check all that apply) Yes, my company will support me through a donation. Yes, my company will match any gifts made by me or my colleagues. No, my company will not support my efforts. Have you participated in a marathon/road race charity program before? Yes No If yes, for which charity and how much money did you raise? Charity Name Amount raised: $ Please outline your plan for meeting your fundraising goal (include additional pages, if needed) My Running Experience: My running level: Beginner Intermediate Advanced Current Weekly Mileage: Typical training pace (min/mile): Number of Boston Marathons I have run: Number of previous marathons (anywhere) I have run: Additional Information: Social networking sites I actively use: Facebook LinkedIn Instagram Vine Twitter (@ ) I have a blog: Yes No If yes, enter web address: Hometown newspaper (please specify town and state):

4 4 You have my authorization to use this information for media, promotion, etc. Yes No Running Singlet Size: T-Shirt Size: My other hobbies/sports/interests/community & volunteer activities: Are you willing to be part of a Team atmosphere for example, participating in Team s, training together if possible, meetings and pre-race get-together? Yes No If no, what is the reason? If you reside out of state, do you have family, social, or business ties in or around Boston, or within Massachusetts?

5 5 Morgan Memorial Goodwill Industries Terms and Conditions for the 2019 Boston Marathon Team Please read the following carefully before signing below. Fundraising Commitment: The minimum commitment required to join Goodwill s Marathon Team and receive an individual entry for the 2019 Boston Marathon is $7,500. A non-refundable deposit of $150 will be charged to your credit card when you are accepted onto the team. The $150 will be applied toward your fundraising minimum and reserves a Boston Marathon number in your name assuming you have followed the fundraising calendar of commitments. The remaining balance is due by April 22, 2019 and can be comprised of donations or personal funds. Valid credit card information must be included with your application to apply for Goodwill s team. The card must not expire before June 1, In the event that you do not meet the minimum donation requirement on April 22, 2019, Goodwill reserves the right to charge the balance owed to your credit card without notice. MasterCard, Visa and American Express are accepted. Cancellation Policy: You may cancel your selection to Goodwill s team for the Boston Marathon due to injury, illness or extenuating circumstances, waiving your responsibility for the $7,500 minimum anytime on or before January 7, To do so, you must contact Nicole Caouette, Events Manager at Goodwill, in writing, on or before the cancellation date. Your $150 deposit fee is non-refundable and you must forfeit the marathon bib number if you cancel your participation by January 7, Starting January 8, 2019, you are responsible for raising the $7,500 minimum, even if for any reason, including injury, you are unable to run in the Marathon. Your marathon waiver is non-transferable if you cancel on or after January 7, Donations raised and received by Goodwill cannot be refunded, even if you cancel on or before January 7, Matching Gift Policy: Many companies match employees charitable contributions. You can check with your employer to see if your company has this program, and ask donors if their employers match gifts. Many companies issue matching gift checks quarterly or semi-annually: therefore if you plan to use a match to reach your minimum, it is your responsibility to contact the matching company to ensure the check will be issued before April 22, If the company s match cycle is past April 22, 2019, the match cannot count towards your minimum. Team Member s B.A.A. Registration: Goodwill will inform you of the details of the B.A.A. registration process after your application is accepted. The B.A.A. charges a race application fee that does not count towards your fundraising commitment. Registering with the B.A.A. and paying the registration fee are your responsibility and must be completed within the deadlines set forth by the B.A.A.. You should NOT contact the B.A.A. directly to secure your number. Publicity Rights: Applicant hereby grants Goodwill the irrevocable, perpetual right to use, in any manner, Applicant s name, photograph, likeness and voice in broadcast, telecast, print and/or in any other account of or relating to the Race, and hereby waives (a) any right to receive compensation for such use and (b) any claim related to such use, including, without limitation, invasion of privacy and right to publicity claims. Release Form and Contribution Agreement: In consideration of my accepting this entry, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights for claims and damages I may have against Morgan Memorial Goodwill Industries, its

6 employees, volunteers, officers and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event, or travel to or from any of the preceding. I further attest and certify that I am 18 years or older, physically fit and have sufficiently trained for participation in this event, and a licensed medical doctor has verified my physical condition. I also grant permission for use of my name and or photograph or voice in broadcast, telecast, print or any other account of this event and agree to waive any compensation for such use. I agree to collect a minimum of $7,500 for Goodwill by April 22, If I have not raised the minimum in donations by that date, I will personally be responsible for the balance owed. I understand that unless I cancel by January 7, 2019 Goodwill reserves the right to charge the balance I owe to my credit card after April 22, I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement was voluntary and not based on or influenced by any representative of Goodwill. In no event shall Applicant fail to turn over to Goodwill all amounts collected as donations in connection with Applicant s participation in the Race, and Applicant hereby agrees to be personally liable to Goodwill for any shortfall and consents to Goodwill/CrowdRise charging the shortfall to Applicant s credit card. In the event that Applicant fails to submit Applicant s valid credit card, Goodwill shall have the right to revoke Applicant s membership on the Team. Applicant hereby consents to any collection action taken by Goodwill against Applicant following Applicant s failure to pay any shortfall and/or for Applicant s failure to turn over all amounts collected by Applicant in connection with Applicant s acceptance on the Team and/or participation in the Race, and further agrees that Goodwill shall be entitled to an award of all costs of collection and reasonable attorney s fees in connection with any such action. If Applicant does not run the Boston Marathon for any reason, including injury, Applicant is still responsible for the fundraising minimum, and Applicant s credit card will be charged as indicated above. Applicant also understands and agrees that all donations are non-refundable. I agree and understand that I am solely responsible for raising the minimum $7,500 and will be faithful to my commitment to Goodwill. Signature: Date: 6 Emergency Contact Information: In the event of an illness, injury or medical emergency arising during the event or in the training and planning sessions for said event, I hereby authorize and give my consent to Goodwill to secure from any accredited hospital, clinic and/or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment, and hospitalization. The following person should be contact in the event of an emergency: Name: Relationship to Runner: Telephone Number: Allergies to medications:

7 Guidelines: - The entry must be used by the person receiving it. It may not be transferred, sold or auctioned to another person. - The runner must properly prepare to finish the Marathon within six hours. - The runner must abide by all rules and regulations regarding the BAA Boston Marathon. - Valid credit card information will be collected from all participating runners when team selection is finalized. Running for Great Kids Team reserves the right to charge the credit card for an unmet fundraising balance. - The runner must agree to wear the Running for Great Kids running shirt while participating in the Marathon. 7 Please complete credit card information on the following page.

8 8 Credit Card Information: MasterCard Visa American Express Name on Card: Address (if different from address on page 1): Card Number: Expiration Date: Signature of Card Holder: Date: