TEAM R E D CROSS
B.A.A. Boston Marathon® Application
120th Boston Marathon - April 18, 2016
Applications will be reviewed on a rolling basis until all Team Red Cross bibs have been assigned.
The American Red Cross of Massachusetts is an official charity partner of the
Boston Athletic Association for the 2016 Boston Marathon®
The American Red Cross of 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 individual entries have been provided to the American Red Cross of
Massachusetts for the 120th Boston 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 Red Cross and is
to be raised through his/her own individual fundraising efforts (per B.A.A. Charity Program rules). Funds raised by Team Red Cross participants
benefit American Red Cross of Massachusetts programs and services.
Send completed applications to:
American Red Cross of Massachusetts
Attn: Team Red Cross
139 Main Street, Cambridge, MA 02142
Phone: 617-274-5243 | Fax: (617) 274-5255
[email protected]
Upon receipt of your completed application, the
American Red Cross of Massachusetts will charge a $40
non-refundable application fee to the credit card provided
with this application.
I. Contact I n formation
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__________________________________________
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CPR/AED Certified
Yes
No
TEAM R E D CROSS
I I. Fu n draisi ng Experie nce
B.A.A. Boston Marathon® Application
(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 by the B.A.A. for participation is $5,000. On average,
funds raised by charity runners exceed $7,000 per runner.
3. What are your plans for raising these funds?
4. Does your company have a matching gifts program?
I I I. R u n n i ng Experie nce
1. Running level:
Beginner
Yes
No
(You may attach an additional page if your answer exceeds the space provided.)
Intermediate
Advanced
2. Current weekly running mileage:________________
3. What is your current running/training regiment?
4. H
ave 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 B.A.A. Boston 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.
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B.A.A. Boston Marathon® Application
IV. P
lease an swer th e followi ng qu estion s so that we can g et to know you.
(You may attach an additional page if your answer exceeds the space provided.)
1. How did you learn about TEAM RED CROSS?
2. What is your experience with the American Red Cross?
Financial Supporter
Recipient of Aid
Please describe your experience:
Volunteer
Blood Donor
Past Team Red Cross Runner
Health/Safety Certification
No Prior Experience
Other
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 Massachusetts.
5. How do you see yourself becoming involved with the American Red Cross of Massachusetts after the marathon?
6. TEAM RED CROSS will hold regular monthly activities for group training and mission engagement. Do you foresee any conflicts
in attending?
Yes
No
If yes, what is the reason?
V. Additional i n formation
(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): __________________________________________________________
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B.A.A. Boston Marathon® Application
4. Current newspaper (please specify town and state): _____________________________________________________________
5. What additional information would you like to share.
6. The American Red Cross of Massachusetts will provide each runner with one Team Red Cross branded jersey to wear on
marathon day. Please select your sizing.
Select one size: Mens
Womens
X-Small
Select style preference:
T-Shirt
Small
Medium
Large
X-Large
Singlet
VI. Terms an d Con dition s - Please read the following carefully before signing.
Fundraising Commitment: A minimum fundraising requirement of
$5,000 is required to join the American Red Cross of Massachusetts
marathon team - Team Red Cross - and receive an individual entry for the
120th Boston Marathon. The $5,000 fundraising minimum requirement
applies to each individual entry provided to the American Red Cross of
Massachusetts by the 2016 B.A.A. Charity Program for the 120th Boston
Marathon. Each applicant offered a bib by the American Red Cross of
Massachusetts 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.
Team Red Cross Manager at the American Red Cross of 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
January 15, 2016, the American Red Cross of Massachusetts will make
every effort to find a replacement from our waiting list. If the American
Red Cross of Massachusetts is unable to secure a suitable replacement, you are responsible for fulfilling the $5,000 fundraising minimum.
No replacements can be made after January 15, 2016 if for any reason,
including injury, you are unable to run in the 120th Boston Marathon.
No donations accepted by our office will be refunded.
The American Red Cross of Massachusetts requires each team
member who accepts a charity bib provided to the American Red
Cross of Massachusetts by the Boston Athletic Association to meet
the following fundraising requirements: a minimum of $2,500 received
by the American Red Cross of Massachusetts by January 28, 2016, and
the remaining balance of the minimum $5,000 received by the American
Red Cross of Massachusetts by April 17, 2016. In the event that you do
not meet the minimum fundraising requirements by the required dates, the
American Red Cross of 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 and meet the minimum fundraising requirement after your credit card has been processed for the remaining balance, the American Red Cross of Massachusetts will reimburse
your card upon written request. The American Red Cross of Massachusetts will not reimburse your card after May 13, 2016. All online fundraising
must be conducted using only the platform provided by the American Red
Cross of Massachusetts. Offline donations will only be counted toward the
fundraising minimum when the funds are received by the American Red
Cross of Massachusetts. You are responsible for submitting all offline
donations to the American Red Cross of Massachusetts. Funds raised by
a Team Red Cross runner cannot be credited to another Team Red Cross
runner’s fundraising requirement.
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 17, 2016. If the company’s match cycle is past April 17,
2016, the match cannot count towards your minimum unless prior
arrangements have been made.
Cancellation Policy: You may decline or cancel your participation with
the American Red Cross of Massachusetts marathon team, waiving your
responsibility for the $5,000 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 the
B.A.A. Registration Fee: The American Red Cross of Massachusetts will
inform you of the details of the B.A.A. registration after your application is
accepted. The B.A.A. charges a $350 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 in January 2016. You should NOT contact the B.A.A. directly to
secure your bib.
Release Form and Contribution Agreement: In consideration of my
accepting this individual entry for the 120th Boston Marathon, 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 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
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B.A.A. Boston Marathon® Application
for such use. I agree to collect a minimum of $2,500 for the American
Red Cross of Massachusetts by January 28, 2016, and the remaining
balance of the minimum $2,500 by April 17, 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 American Red Cross of 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 that the
decision to sign this agreement was voluntary and not based on or
influenced by any representation of the American Red Cross of
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
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.
I n formation re lease - 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
E merg e ncy Contact I n formation - 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 I n formation - 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 S ig natu re an d Date
________________________________________________________________ Name
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_________________________
Date