117th B.A.A. Boston Marathon - April 15, 2013 Applications will be reviewed on a rolling basis until all Team Red Cross bibs have been assigned. Team Red Cross is an official charity team for the 117th Boston Marathon The American Red Cross of Eastern Massachusetts is seeking applicants for TEAM RED CROSS who have a passion for running and a commitment to supporting the American Red Cross mission. A limited number of bibs are available. A qualifying time is not required for participation but applicants must be able to complete a marathon within six hours. Funds raised by Team Red Cross participants will benefit American Red Cross programs and services. Each runner will be required to raise a minimum of $4,000 to participate through his/her own individual fundraising efforts (per B.A.A. Charity Program rules). Runners who have secured a marathon bib number already through the Boston Athletic Association are invited to participate with Team Red Cross. Contact us for more information. Send completed applications to: TEAM RED CROSS Attn: Nicole Marcotte American Red Cross of Eastern Massachusetts 139 Main Street, Cambridge, MA 02142 Phone: 617-274-5243 Fax: (617) 274-5255 Nicole.Marcotte@redcross.org Upon receipt of your completed application, the American Red Cross of Eastern Massachusetts will charge a $35 non-refundable application fee to the credit card provided with this application. If you are selected for TEAM RED CROSS, your $35 application fee will be credited toward your fundraising minimum. I. Contact Information Last Name First 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 Pg. 1 of 5
II. Fundraising Experience 1. Have you participated in a marathon/road race charity program before? If yes, for which charity and how much money did you raise? (please list most recent first) 2. What will your fundraising goal be for the American Red Cross of Eastern Massachusetts? $ (minimum required is $4,000) 3. What are your plans for raising these funds? 4. Does your company have a matching gifts program? Yes No III. Running Experience 1. Running level: Beginner Intermediate Advanced 2. Current weekly running mileage: 3. What is your current running/training regiment? 4. Have you completed a marathon or half marathon before? If yes, please provide the event names, dates, distance and your times for the last 3 years. 5. Have you had any recent injuries or surgeries? If yes, please describe. Pg. 2 of 5
IV. Please answer the following questions so that we can get to know you. 1. How did you learn about TEAM RED CROSS? 2. What is your experience with the American Red Cross? Volunteer Blood Donor Health/Safety Certification Financial Supporter Recipient of Aid Past Team Red Cross 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 the American Red Cross of Eastern Massachusetts. 5. How do you see yourself becoming involved with the American Red Cross of Eastern Massachusetts after the marathon? 6. TEAM RED CROSS will hold regular monthly activities for group training and planning. Do you foresee any conflicts in attending? Yes No If yes, what is the reason? V. Additional information 1. Social Networking Sites I use: Facebook LinkedIn Twitter Tumblr Pinterest Other: 2. I 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): Pg. 3 of 5
5. What additional information would you like to share. 6. The American Red Cross of Eastern Massachusetts will provide each runner with one Team Red Cross branded T-shirt or singlet to wear on marathon day. Please select your style preference and sizing. Select one style: T-shirt Singlet Select one size: Mens Womens X-small Small Medium Large X-large VI. Terms and Conditions - Please read the following carefully before signing. Fundraising Commitment: A minimum donation of $4,000 is required to join the American Red Cross of Eastern Massachusetts marathon team and receive an individual entry for the 2013 Boston Marathon. Each applicant offered a bib number by the American Red Cross of Eastern Massachusetts will be charged a $100 deposit to the credit card provided on the application to hold the bib number in the applicant s name. This deposit will be applied to the runner s fundraising minimum. The American Red Cross of Eastern Massachusetts requires each team member to meet the following fundraising requirements: a minimum of $2,000 received by our organization by February 15, 2013, and the remaining balance of the minimum $4,000 by April 15, 2013. In the event that you do not meet the minimum donation by the required dates, the American Red Cross of Eastern Massachusetts 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 after your credit card has been processed for the remaining balance, we will reimburse your card upon written request. We will not reimburse your card after May 15, 2013. All online fundraising must be conducted using only the platform provided by the American Red Cross of Eastern Massachusetts. Offline donations will only be counted toward the fundraising minimum when the funds are received by the American Red Cross of Eastern Massachusetts. Runners are responsible for submitting all offline donations to the American Red Cross of Eastern Massachusetts. Cancellation Policy: You may decline or cancel your participation with the American Red Cross of Eastern Massachusetts marathon team, waiving your responsibility for the $4,000 minimum, within 48 hours of being offered 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 Nicole Marcotte at the American Red Cross of Eastern Massachusetts in writing within the required time period. If unforeseen circumstances occur and you wish to cancel your participation between the time you accept and February 1, 2013, the American Red Cross of Eastern Massachusetts will make every effort to find a replacement from our wait list. If the American Red Cross of Eastern Massachusetts are unable to secure a suitable replacement, you are responsible for fulfilling the $4,000 fundraising minimum. No replacements can be made after February 1, 2013 if for any reason, including injury, you are unable to run in the Boston Marathon. 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 April 15, 2012. If the company s match cycle is past April 15, 2013, the match cannot count towards your minimum unless prior arrangements have been made. B.A.A. Registration Fee: The American Red Cross of Eastern Massachusetts will inform you of the details of the B.A.A. registration after your application is accepted. The B.A.A. charges a $300 race application fee that does not count towards your fundraising minimum and cannot be paid for using funds raised toward your minimum requirements. This fee will be collected separately on February 1, 2013. 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 the American Red Cross of Eastern Massachusetts, 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 to collect a minimum of $2,000 for the American Red Cross of Eastern Massachusetts by February 15, 2013, and the remaining balance of the minimum $4,000 by April 15, 2013. 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 American Red Cross of Eastern Massachusetts 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 Pg.4 of 5
that the decision to sign this agreement was voluntary and not based on or influenced by any representation of the American Red Cross of Eastern Massachusetts. 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 American Red Cross of Eastern Massachusetts 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 to these terms and conditions. Information release - I give to the American Red Cross, its designees, agents and assigns, unlimited 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. Yes No Emergency Contact Information - The following person should be contacted in the event of an emergency: Name: Relationship: 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 Signature and Date Name Date Pg. 5 of 5