TCS New York City Marathon Team Application
Run with Team Donate Life to Help Save Lives!
2016 Charitable Spots – 5 Spots Available
Thank you for your interest in running the NYC Marathon on November 6th to support
organ, eye, and tissue donation. Your support makes a difference as we work together to
save lives and raise awareness for this important and lifesaving cause. Please note the
fundraising minimum is $2,500 and is tax deductible. Deadline to apply is March 1, 2016.
Confirmed Team Members will be notified no later than April 1, 2016.
Please submit application to Karen Cummings at [email protected] or by fax to
(646) 291-4600.
First Name ________________________________ Last Name____________________________________
Birthday (mm/dd/yr) ____ /____ / _____
Address _______________________________________________________________________________
City _______________________________________ State______________________________________
Telephone Number (home) _____________________________ (cell) ______________________________
Preferred Email Address __________________________________________________________________
Have you ever run a marathon before? _______YES ________ NO
If yes, when was the last marathon you ran? __________________________________________________
How did you learn about these available spots? ________________________________________________
What is your connection, if any, to organ, eye, and tissue donation?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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Why would you like to run for organ, eye, and tissue donation?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
If you are selected to be a member of the team what will your personal fundraising goal be?
______________________________________________________________________________________
(Minimum required is $2,500)
Terms and Conditions:
Fundraising Commitment: Each runner must raise a minimum of $2,500. Each runner will be supplied
with a team jersey. Other benefits will be outlined when the team members have been selected. In the event
that you do not meet the fundraising minimum by October 24, 2016, LiveOnNY reserves the right to
charge the balance owed to your credit card, unless prior arrangements have been made. A credit
card authorization form must be completed once the runner is accepted to the team.
Participant Requirements:
Complete and submit the Team Donate Life Team application by March 1, 2016
Complete and submit media release form by April 30, 2016
Provide LiveOnNY with a personal photo by April 30, 2016
Run the marathon in the Team Donate Life jersey that LiveOnNY will provide
Participate in a team photo either prior to or on the day of the race
Commit to promote the cause using social media (Facebook, Twitter and Instagram)
o Requirement of 4 posts across any platform
 Participate in any potential media (print, TV or online) opportunities about Team Donate Life
 Attend a team meal prior to race day
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Use of Funds: Funds raised will support LiveOnNY’s public education programs for organ, eye, and tissue
donation. LiveOnNY is a non-profit, tax exempt 501c3 and a federally designated organ procurement
organization, incorporated under Section 402 of the Not-for-Profit Corporation Law of the State of New
York. All contributions made to LiveOnNY are fully tax deductible according to the laws that govern
charitable giving.
Cancellation Policy: You many cancel your participation in the TCS New York City Marathon within 48
hours of confirming your participation with LiveOnNY. To do so, you must contact Karen Cummings
([email protected]) at LiveOnNY in writing. After 48 hours, you are responsible for raising the
$2,500 minimum requirement for fundraising. There are no allowable exclusions for any reason to the
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fundraising minimum requirement including injury resulting in an inability to run the 2016 TCS New York
City Marathon.
Donations raised and received by LiveOnNY will not be refunded, even if you leave the team before
the fundraising deadline of October 24, 2016.
Team Registration: A LiveOnNY representative will review participation details of Team Donate Life
after you have been confirmed as a member. This notification will occur no later than April 1, 2016. For
additional questions, please call Karen Cummings at (646) 291-4454.
I agree to the terms and conditions above:
Signature: ___________________________________________________________________________
Print Name: __________________________________________________________________________
Date: ________________________________________________________________________________
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