Morgan Memorial Goodwill Industries Running for Great Kids 2015 Boston Marathon Team Application

Transcription

1 1 Morgan Memorial Goodwill Industries Running for Great Kids 2015 Boston Marathon Team Application Applications will be accepted on a rolling basis. Send completed applications to: Erin Flaherty Barfield Events Manager Morgan Memorial Goodwill Industries 1010 Harrison Ave. Boston, MA eflaherty@goodwillmass.org Phone: Fax: Please print clearly Last Name First Name Address City State Zip Home/Cell Phone Employer Title Work Address City State Zip Work Phone Fax Address Date of Birth Does your company have matching gifts program? Yes No I would like to be contacted at: Home/Cell Work

2 2 Fundraising Experience 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: $ What will your fundraising goal be for Goodwill? (minimum required is $4,500) $ What are your ideas for raising these funds? Please be as specific as possible. Please answer the following questions so that we can get to know you a little better. How did you learn about the Goodwill program? Have you had any experience with Goodwill in Boston or other Goodwill programs? Yes No If yes, how?

3 3 What other community organizations are you involved with? Have you fundraised for any of these organizations in the past? Please describe why you would like to run for Goodwill. Goodwill will host a few team meetings before the Marathon. Will you be able to attend these meetings? Yes No If no, what is the reason? Will you attempt to participate in our optional team workouts held bi-weekly? Yes No

4 4 If you reside out of state, do you have family, social, or business ties in or around Boston, or within Massachusetts? Goodwill plans proactive media outreach before and after the Marathon. Will Goodwill have approval to use your name and/or photo in conjunction with media outreach? If no, why?

5 5 Morgan Memorial Goodwill Industries Terms and Conditions for the 2015 Boston Marathon Team Please read the following carefully before signing below. Fundraising Commitment: A minimum donation of $4,500 is required to join Goodwill s Marathon Team and receive an individual entry for the 2015 Boston Marathon. A non-refundable deposit of $100 will be charged to your credit card if you are accepted onto the team. The $100 will be applied toward your fundraising minimum and reserves a Boston Marathon number in your name. The remaining balance is due by Friday, May 1, Valid credit card information must be included with your application to apply for Goodwill s team. The card must not expire before July 1, In the event that you do not meet the minimum donation requirement on May 1, 2015, 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 participation with Goodwill s team for the Boston Marathon, waiving your responsibility for the $4,500 minimum anytime on or before January 9, To do so, you must contact Erin Flaherty Barfield, Events Manager at Goodwill, in writing, on or before the cancellation date. Your $100 deposit fee is non-refundable and you must forfeit the marathon bib number if you cancel your participation by January 9, After January 9, 2015, you are responsible for raising the $4,500 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 after January 9, Donations raised and received by Goodwill cannot be refunded, even if you cancel before January 9, 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 May 1, If the company s match cycle is past May 1, 2015, 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 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. 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 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 competition 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 $4,500 for Goodwill by May 1, If I have not raised the minimum in donations by that date, I will personally be responsible for

6 the balance owed. I understand that unless I cancel by January 9, 2015 Goodwill reserves the right to charge the balance I owe to my credit card after May 1, 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. I agree and understand that I am solely responsible for raising the minimum $4,500 and will be faithful to my commitment to Goodwill. Signature: Date: 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: 6 Name: Relationship to Runner: Telephone Number: Allergies to medications: Credit Card Information: MasterCard Visa American Express Card Number: Expiration Date: Name on Card: Address (if different from address on page 1): Signature of Card Holder: Date: To be completed by Goodwill: Approved by: Name Signature Date