TEAM SANDY HOOK PROMISE - TCS NYC MARATHON APPLICATION 2016 TCS NYC Marathon November 6, 2016 Applications will be reviewed on a rolling basis until all Team Sandy Hook Promise bibs have been assigned. The Sandy Hook Promise is an official Bronze Level Charity Partner of the 2016 TCS NYC Marathon Sandy Hook Promise is seeking applicants for Team Promise who have a passion for running and a commitment to supporting our mission to Prevent gun-related deaths due to crime, suicide and accidental discharge so that no other parent experiences the senseless, horrific loss of their child. A limited number of individual entries have been provided to the Sandy Hook Promise Foundation for the 2016 TCS NYC Marathon. A qualifying time is not required for participation, but applicants must be able to complete a marathon within six hours. A minimum fundraising requirement is assigned to each individual entry to participate with Team Sandy Hook Promise and is to be raised through his/her own individual fundraising efforts (per NYRR Charity Program rules and the use of the CrowdRise platform and Sandy Hook Promise Foundation campaign page). Funds raised by Team Sandy Hook Promise benefit Sandy Hook Promise Foundation programs and services. Send completed applications to: Attn: NYC Marathon Team PO Box 3489, Newtown, CT 06470 Phone: 203-304-9780 Fax: 203-491-2058 team@sandyhookpromise.org Upon receipt of your completed application, the Sandy Hook Promise Foundation will charge a $10 nonrefundable application fee to the credit card provided with this application. I. Contact Information First Name Last Name Address City State Zip Country Home Phone Cell Phone Employer Title
Work Address City State Zip Country Work Phone Preferred Email Address Date of Birth CPR/AED Certified Yes No II. Fundraising Experience (You may attach an additional page if your answer exceeds the space provided.) 1. Have you ever participated in an athletic fundraising event for charity? If yes, for which charity and how much money did you raise? (please list most recent first) Charity Name event type: raised: $ Charity Name event type: raised: $ Charity Name event type: raised: $ 2. What will your fundraising goal be if you are selected for Team Red Cross 2016? $ The minimum fundraising requirement set for participation is $5,000. on average, funds raised by charity runners exceed $5,000 per runner. 3. What are your plans for raising these funds? 4. Does your company have a matching gifts program? Yes No III. Running Experience (You may attach an additional page if your answer exceeds the space provided.) 1. Running level: Beginner Intermediate Advanced 2. Current weekly running mileage: 3. What is your current running/training regimen? 4. Have you ever completed a marathon or half marathon? If yes, please provide the event names, dates, distances and times for the last 3 years.
5. If you have completed the NYC Marathon in the past, please indicate year(s) and your bib type (qualified/charity). 6. Have you had any recent injuries or surgeries? If yes, please describe. IV. Please answer the following questions so that we can get to know you. (You may attach an additional page if your answer exceeds the space provided.) 1. How did you learn about Team Sandy Hook Promise? 2. What is your experience with Sandy Hook Promise? Volunteer Donor Program Participant Past Team Runner No Prior experience Other Please describe your experience: 3. What community organizations are you involved in? Please note any positions or roles held (such as board member, volunteer, sustainer, etc) and any related fundraising experience. 4. Describe why you would like to run for Sandy Hook Promise. 5. How do you see yourself becoming involved with Sandy Hook Promise after the marathon? 6. Sandy Hook Promise may plan activities for group training, camaraderie and mission engagement. Do you foresee any conflicts in attending? Yes No If yes, what is the reason?
V. Additional Information (You may attach an additional page if your answer exceeds the space provided.) 1. What social networking sites do you use? Facebook LinkedIn Twitter Tumblr Pinterest other: 2. Do you have a blog? No Yes, here is the web address: 3. Hometown newspaper (please specify town and state): 4. Current newspaper (please specify town and state): 5. What additional information would you like to share and please (?). 6. Sandy Hook Promise will provide each runner with one Team branded jersey to wear on marathon day. Please select your sizing. Select one size: mens Womens X-small small medium Large X-Large Select style preference: T-shirt singlet VI. TERMS AND CON DITIONS - Please read the following carefully before signing. Fundraising Commitment: A minimum fundraising requirement of $5,000 is required to join the Sandy Hook Promise Foundation marathon team and receive an individual entry for the 2016 TCS NYC Marathon. The $5,000 fundraising minimum requirement applies to each individual entry provided to the Sandy Hook Promise Foundation by the 2016 NYRR Charity Program for the 2016 TCS NYC Marathon. Each applicant offered a bib by the Sandy Hook Promise Foundation will be charged a $100 non-refundable deposit to the credit card provided on this application to hold the bib in the applicant s name. This deposit will be applied to the runner s fundraising minimum. The Sandy Hook Promise Foundation requires each team member who accepts a charity bib provided to the Sandy Hook Promise Foundation by the New York Road Runners to meet the following fundraising requirements: a minimum of $5,000 received by the Sandy Hook Promise Foundation by December 1, 2016. In the event that you do not meet the minimum fundraising requirements by the required date, the Sandy Hook Promise Foundation reserves the right to charge the balance owed to the credit card provided on your application, unless prior arrangements have been made. MasterCard, Visa and American Express are accepted. If you continue to fundraise and meet the minimum fundraising requirement after your credit card has been processed for the remaining balance, the Sandy Hook Promise Foundation will reimburse your card upon written request. All online fundraising must be conducted in accordance with Sandy Hook Promise Foundation practices including the use of the platform requirements as determined by the Charity Partner Agreement between Sandy Hook Promise Foundation and the NYRR TCS NYC Marathon. Offline donations will only be counted toward the fundraising minimum when the funds are received by the Sandy Hook Promise Foundation. You are responsible for submitting all offline donations to the Sandy Hook Promise Foundation. Funds raised by a Team Sandy Hook Promise runner cannot be credited to another Team Sandy Hook Promise runner s fundraising requirement. Cancellation Policy: Official notice that you have a spot on the marathon team will be sent to you at the email address you provided in this application. You may decline or cancel your participation with the Sandy Hook Promise marathon team, canceling your responsibility for the $5,000 minimum, within 48 hours of when we send you official notice that you have a spot on our team. If you cancel within the 48 hour time period, you will be refunded your $100 deposit. To decline or cancel, you must contact the Team Administrator of Sandy Hook Promise in writing within the required time period. If unforeseen circumstances occur and you wish to cancel your participation between the time you accept and September 1, 2016, the Sandy Hook Promise Foundation will try to find a replacement from our waiting list. If the Sandy Hook Promise Foundation is unable to secure a suitable replacement, you are responsible for fulfilling the $5,000 fundraising minimum. No replacements can be made after September 8, 2016 if for any reason, including injury, you are unable to run in the 2016 TCS NYC Marathon. All runners must be registered with NYRR by September 15, 2016. No donations accepted by our office will be refunded. Matching Gift Policy: many companies match employee 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 December 1, 2016. If the company s match cycle is past December 1, 2016, the match cannot count towards your minimum unless prior arrangements have been made.
NYRR TCS NYC Marathon Race Registration Fee: The Sandy Hook Promise Foundation will pay the runner race registration fee after your application is accepted and executed and the runner registers for entry on My NYRR site. This fee does not affect minimum fundraising requirements. Release Form and Contribution Agreement: In consideration of Sandy Hook Promise Foundation accepting this individual entry for the 2016 TCS NYC Marathon, I hereby for myself, my heirs, executors, and administrators, waive and release any and all rights for claims and damages I may have against the Sandy Hook Promise Foundation, 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 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 that if I am offeredaccept a bib, I will fundraise a minimum of $5,000 for the Sandy Hook Promise Foundation by December 1, 2016. If I have not reached the fundraising minimum by that date, I will personally be responsible for the balance owed. I understand that unless I cancel within the required time period, the Sandy Hook Promise Foundation reserves the right to charge the balance I owe to my credit card. 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 representation of the Sandy Hook Promise Foundation. 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 the Sandy Hook Promise 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. I agree notice will be sent to me at the e-mail address provided in Section 1 of this Application. I will inform Sandy Hook Promise Foundation in writing of any change in my email address. I HAVE READ AND AGREE TO THESE TERMS AND CONDITIONS. Sandy Hook Promise Foundation permission to use, publish and republish in and any form or media, information about me and reproductions of my likeness (photographic or otherwise) and my voice, with or without identification of me by name. EMERGENCY CONTACT INFORMATION - The following person should be contacted in the event of an emergency: Name: Relationship: Home Address: Home Phone: Work Phone: Cell Phone: Allergies to medications: CREDIT CARD INFORMATION - Please use the credit card below for billing: MasterCard Visa American express Card Number: expiration date: CSV (security code): Name on Card:
Billing Address for Card: Signature of Card Holder: date: APPLICANT SIGNATU RE AN D DATE Name date