2017 TCS New York City Marathon Charity Entry
In Support of Achilles International
Thank you for your interest in becoming a supporter of Achilles International through your
participation in the TCS New York City Marathon on November 5, 2017.
For a guaranteed entry, each charity entrant must commit to make a donation or raise funds
totaling $3,000 or more to Achilles. A 501 (c) 3 since 1983, your tax-deductible donations will
directly support Achilles International athletes with disabilities in athletic competitions.
FUNDRAISING COMMITMENT: A $3,000 minimum fundraising donation is required to
secure your guaranteed entry into the Marathon. Participants are also required to pay the TCS
New York City Marathon registration fee. Your credit card information is required as a
guarantee of the pledge. In the event that you are unable to meet the minimum fundraising
requirement of $3,000 by October 25th, 2017, Achilles reserves the right to charge the balance to
the credit card we have on file. We accept American Express, Visa, & MasterCard. The amount
charged to your credit card will be considered a charitable donation and is non-refundable. A
confirmation of this donation for tax purposes will be mailed to you. We will let you know
before charging the card.
CANCELLATION POLICY: After you sign the contract and have been approved by Achilles,
you will receive an electronic invitation to confirm your entry with the TCS New York City
Marathon. Once you are electronically entered in the system as confirmed, you cannot cancel
your obligation to fulfill your fundraising goal for Achilles. Your guaranteed entry is nontransferable and non-refundable. Please contact Sarah Phillips at
[email protected] or at 212-354-0300 with any questions or concerns before
final agreement is made by both parties. Once you are electronically registered through the
online system, you are responsible for raising the $3,000 minimum, even if for any reason,
including injury, you are unable to physically participate in the marathon.
Release Form & Contribution Agreement:
In accepting this entry, I hereby for myself and anyone entitled to act on my behalf, waive and
release any and all rights to claim for damages I may have against Achilles International and
sponsors for all injuries suffered by me in the events pertaining to and including the TCS New
York City Marathon 2017. 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.
Fax, email, or mail entire completed form to:
Achilles International attn: Sarah Phillips
42 W. 38th St. #400, NY, NY 10018
FAX: 212-354-3978; [email protected]
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2017 TCS New York City Marathon Charity Entry
In Support of Achilles International
Applicant’s Signature
Date
Name (Print)
Circle one: Am Ex
MC
VISA
Credit Card #
Exp. Date
Sec. Code
Billing Address for credit card
City
State
Phone
Zip Code
Email
PERSONAL INFORMATION of MARATHON PARTICIPANT:
First Name
Middle
Street Address
(if different from billing address)
City
State
Last Name
Zip
Fax, email, or mail entire completed form to:
Achilles International attn: Sarah Phillips
42 W. 38th St. #400, NY, NY 10018
FAX: 212-354-3978; [email protected]
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2017 TCS New York City Marathon Charity Entry
In Support of Achilles International
Email
(
)
(
)
Home Phone
Work Phone
(
(
)
Mobile Phone
)
Fax
Gender (M/F)
Shirt Size Preference
Age
Date of Birth (mm/dd/yy)
Occupation
Employer
Emergency Contact Name
Emergency Contact Number
How many marathons have you completed? ________
Have you ever completed the NYC Marathon? ______ If yes, what year?________________
What is your predicted time for the 2017 NYC Marathon? ____Hr ____ Min ____ Sec
Personal Story Optional:
Why did you choose to support Achilles International through the NYC Marathon?
Fax, email, or mail entire completed form to:
Achilles International attn: Sarah Phillips
42 W. 38th St. #400, NY, NY 10018
FAX: 212-354-3978; [email protected]
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2017 TCS New York City Marathon Charity Entry
In Support of Achilles International
If you are lucky enough to have a chapter of Achilles International where you
reside, are you interested in becoming involved with the team?
Fax, email, or mail entire completed form to:
Achilles International attn: Sarah Phillips
42 W. 38th St. #400, NY, NY 10018
FAX: 212-354-3978; [email protected]
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