Touch Foundation s Application Form and Fundraising & Release Agreement for the 2017 TCS New York City Marathon on November 5, 2017 PART I: APPLICATION FORM Applications will be accepted on a rolling basis. The sooner you submit your Application (pp. 1-3), the better your chances of securing entry on our team. We intend to advise all applicants of their application s status within 3 days of submission. Runner Information Today s date: Name: Email address: Phone number: Street address: City, state, zip code: Date of birth: Gender: Occupation: Please choose a T-shirt size. Touch will be providing running shirts for all members of the team: Men s Small Women s Small Men s Medium Women s Medium Men s Large Women s Large Men s X-Large Women s X-Large 1
Runner Background 1. Why are you interested in running with Team Touch in particular and supporting the Touch Foundation s efforts to address the shortage of health workers in Africa? 2. Would you be interested in continuing your relationship with Touch after completing the 2017 TCS New York City Marathon? Please check any boxes below that are of interest to you. Holding a Friendraiser/Fundraiser Volunteering for Touch Trip to Tanzania The Kilimanjaro Marathon Joining Afya Leadership Group 3. What is your strategy for raising the minimum of $3,500 for the Touch Foundation? Do you have any experience in fundraising or raising money for charities? 4. What is your running level and experience? Have you run any half-marathons or full marathons before? If so, where and what year? (Prior experience running races is not required.) 5. How did you hear about Touch Foundation? 6. If you have already received a bib in the 2017 TCS New York City Marathon through the lottery or other means but would still like to join our team and raise money for the Touch Foundation, please let us know your entrant number. (Please also complete the Fundraising & Release Agreement on the next page.) 2
PART II: FUNDRAISING AND RELEASE AGREEMENT As an Applicant to be a member of the Touch Foundation, Inc. Team at the 2017 TCS New York City Marathon, if accepted, I hereby agree to the following terms and conditions of participation: 1. I will raise a minimum of $3,500 for Touch Foundation, Inc. Valid credit card information is required as a guarantee against this pledge. 2. I will have raised (and Touch Foundation needs to have received) the below amounts by the designated deadlines: a. $1,600 by September 24, 2017. If I have not met this requirement, my credit card will be charged for the amount of $1,600 less any funds received in my name from donors by September 24, 2017. b. $3,500 by November 20, 2017. If by November 20, 2017 any funds received in my name do not total the full minimum pledge of $3,500, my credit card will be charged the remaining balance of that amount to fulfill the pledge. 3. I will pay to Touch Foundation a deposit of $600 by credit card within one week after acceptance of my application in order to reserve my spot on Team Touch. The deposit of $600 will be charged to my credit card, and returned upon Touch s receipt of the $3,500 minimum pledge and written request. 4. I will pay directly to the New York Road Runners the registration fee of $255 for NYRR members, $295 for non-nyrr members, or $358 for non-us residents by the NYRR when you register for the race. Once NYRR s enrollment period has ended, there will be no cancellations or deferrals. If registration requirements are not met by NYRR deadline, I will be held contractually responsible for the total fundraising pledge and will lose my spot on the Team. All NYRR fees are non-refundable. 5. I will abide by the rules of the 2017 TCS New York City Marathon as stated in all official race information. 6. I may not cancel or defer without written approval by Touch Foundation. Once approved, I may only defer once, and will only be deferred to the following calendar year. If I defer, I forfeit a refund of my deposit. If I cancel, I am still required to raise the $3,500 minimum. 3
7. I am fully aware of and appreciate that training for and running a road race may result in accidents or serious injury. I am voluntarily participating in the Touch Foundation 2017 TCS New York City Marathon Team with complete knowledge of associated risks, and I agree to accept responsibility for all risks of injury and hereby release Touch Foundation, Inc., and its employees, representatives, and affiliates, from and against any and all rights and claims for damages, losses, costs, expenses, injuries, and liabilities resulting from or in connection with participation in 2017 TCS New York City Marathon. I also attest that I will not sue or make claim against the Touch Foundation for any such claims. I understand that the above release is binding upon my heirs, assigns, affiliates and legal representatives. 8. I understand that running a road race is a potentially hazardous activity that may result in accidents or serious injury. I affirm that I am physically fit and will be prepared for participation in a marathon. I understand that I should not enter and run unless I am medically able to do so and properly trained. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, and the effects of weather, traffic and course conditions, all such risks being known and understood by me. I also acknowledge full and sole responsibility for my own medical expenses and that I am responsible for any and all medical expenses on my behalf. 9. I hereby grant my consent and permission to Touch Foundation, Inc. and its employees use of any and all information submitted in my application, and/or my name, photograph or video footage for any purpose, including any print/web/telecast promotional materials relating to the event. By signing this Fundraising and Release Agreement, I have indicated that I have read, understand and agree to the fundraising commitment and release above. (Please continue to the next page) 4
I agree to abide by all terms as stated in this Fundraising and Release Agreement, including the need to raise and collect a minimum of $3,500 for the Touch Foundation, Inc. by November 20, 2017 and abide by the rules of the 2017 TCS New York City Marathon as stated in all official race information. Applicant Name: Applicant Signature: Date: Credit card info: Type of Card: Visa MasterCard American Express Card number: Expiration date: Name on card: Signature: Thank you for supporting Touch Foundation, Inc.. Together, we will help train health workers and save lives in Africa. Touch Foundation, Inc. is a nonprofit corporation formed under the laws of Connecticut. You may obtain a copy of our annual report by writing to us at 711 Third Avenue, 4th Floor, New York, NY 10017 or by writing to the Office of the Attorney General, Department of Law, Charities Bureau, Attn.: FOIL Officer, 120 Broadway, New York, NY 10271. Touch Foundation is a public charity recognized under Section 501(c)(3) of the Internal Revenue Code. Contributions to Touch Foundation (including contributions which you make or raise from others) are tax deductible to the extent allowed by applicable law. As required by federal law, Touch Foundation retains discretion and control over all contributions received in support of its grants to foreign charities. Submission instructions: Please scan and e-mail your application and fundraising agreement to Bianka Patsalos-Fox, Development Associate, at bianka_patsalosfox@mckinsey.com or mail it to, Touch Foundation, Inc., P.O. Box 1420, New York, NY 10150, USA. All applications must be received by September 1, 2017. The sooner you submit your Application (pp. 1-3), the better your chances of securing entry on our team. 5