2013 ING New York City Marathon Request to Join The Bone Marrow Foundation Team
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1 2013 ING New York City Marathon Request to Join The Bone Marrow Foundation Team Thank you for your interest in running on November 3rd in the ING New York City Marathon on behalf of The Bone Marrow Foundation. Please complete the application below and return it to The Bone Marrow Foundation by faxing it to or ing it to Please retain a copy for your records. CONTACT INFORMATION Name: Male Female Address: City: State: Zip: Phone: Date of Birth: Add contact information to The Bone Marrow Foundation s mailing lists HISTORY Briefly tell us about yourself and why you would like to run on behalf of The Bone Marrow Foundation: ~ 1 ~
2 Have you participated in any programs or events from The Bone Marrow Foundation? Yes No If yes, please describe: Have you completed a marathon before? Yes No If yes, when? Have you fundraised for a charity before? Yes No If yes, please describe the activity and amount raised. Please provide a reference at the charity and contact information. Reference: Title: Phone: PARTICIPATION REQUEST Please consult the Terms and Conditions (starting on page 3) before completing this section. You would like to request a guaranteed race entry on The Bone Marrow Foundation Team. You already have a guaranteed race entry and would like to join The Bone Marrow Foundation Team. If you have a fundraising goal beyond the minimum for your selected participation, what is it? CONSENT AND AUTHORIZATION I have carefully read and understood the Terms and Conditions for joining The Bone Marrow Foundation Team for the 2013 ING New York City Marathon. If I am invited to join The Bone Marrow Foundation Team, I agree to abide by the Terms and Conditions, including the fundraising requirement for my selected participation, if any. If I fail to meet the required fundraising minimum, I authorize The Bone Marrow Foundation to charge the credit card listed below for the remaining balance. I certify that my participation in the 2013 ING New York City ~ 2 ~
3 Marathon is voluntary and I will not hold The Bone Marrow Foundation responsible for any injuries or adverse effects suffered by me in training for or participating in the marathon. I also grant permission for The Bone Marrow Foundation to use my name and/or image in materials related to the Foundation s participation in the 2013 ING New York City Marathon. Print Name: Signature: Date: If the runner is under the age of 18, a parent or guardian s consent and signature is required. Print Name: Relationship to runner: Signature: Date: CREDIT CARD INFORMATION The credit card listed below will be charged the non-refundable deposit of $25.00 and any remaining balance of the fundraising minimum. Cardholder s Name: AmEx Visa MC Card Number: Exp. Date: Billing Address: City: State: Zip: TERMS AND CONDITIONS Please carefully read the section appropriate for your desired participation in The Bone Marrow Foundation Team for the 2013 ING New York City Marathon. Runners requesting a guaranteed race entry on The Bone Marrow Foundation Team Deposit and Fundraising Minimum Bone Marrow Foundation Team is required to raise a minimum of $3, for the Foundation. Once the runner has accepted the invitation to join the team, a non-refundable deposit of $25.00 will be charged to the credit card listed in the runner s application. The runner must raise at least $1, of the fundraising minimum by September 25, 2013, and the remaining balance must be submitted to The Bone Marrow Foundation by November 30, ~ 3 ~
4 A credit card (American Express, MasterCard, or Visa) valid through January 2014 must be provided in order to be eligible to join The Bone Marrow Foundation Team. Once the runner has accepted the invitation to join the team, the $25.00 non-refundable deposit will be charged to this credit card. The deposit will count towards the runner s fundraising minimum. The credit card will not be charged again unless the required fundraising minimum is not met by the November 30, 2013 deadline, at which time the balance required to meet the $3, minimum will be charged. Cancellation Bone Marrow Foundation Team may cancel participation by contacting The Bone Marrow Foundation in writing on or before August 1, Cancellation of participation in The Bone Marrow Foundation Team removes the runner s obligation to meet the $3, fundraising minimum and cancels the runner s guaranteed entry for the 2013 ING New York City Marathon. After the August 1, 2013 deadline, if a runner approved to receive a guaranteed entry for the 2013 ING New York City Marathon as a member of The Bone Marrow Foundation Team decides not to run for any reason (including injury), the runner is still responsible for meeting the $3, fundraising minimum. Funds raised before a runner s cancellation or decision not to run will not be refunded, nor will the runner s $25.00 deposit. Marathon Registration Bone Marrow Foundation Team will receive official registration details from the Foundation after the runner s application is accepted. The runner will be responsible for the processing and entry fees charged by The ING New York City Marathon and these fees do not count toward the runner s fundraising minimum. Currently, the processing fee for the ING New York City Marathon 2013 is $11.00, and the entry fee is $ for New York Road Runners members (domestic), $ for non-members (domestic), and $ for international entrants not entered through International Travel Partners. Runners who have a guaranteed race entry and are requesting to join The Bone Marrow Foundation Team. Joining Fees and Fundraising Minimum A runner who has obtained a guaranteed entry for the 2013 ING New York City Marathon by other means can request to join The Bone Marrow Foundation Team and fundraise in support of the Foundation. There is no fundraising minimum for runners who already have a guaranteed entry, but the runner will be asked to set a realistic personal fundraising goal. A non-refundable $25.00 fee is required to join The Bone Marrow Foundation Team. Once the runner has accepted the invitation to join the team, the $25.00 fee will be charged to this credit card. The joining fee can be counted toward the runner s personal fundraising goal. ~ 4 ~
5 Cancellation A runner who already has a guaranteed entry for the 2013 ING New York City Marathon may cancel participation with The Bone Marrow Foundation Team by contacting the Foundation in writing at any time. Funds raised before a runner s cancellation or decision not to run will not be refunded, nor will the runner s $25.00 joining fee. Marathon Registration The Bone Marrow Foundation is NOT responsible for facilitating registration for or obtaining the official race number for a runner who has obtained a guaranteed entry for the 2013 ING New York City Marathon by other means. The runner is responsible for registration and the accompanying fees charged by the ING New York City Marathon. ~ 5 ~
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