2017 TCS New York City Marathon / Team Stop The Clot®
Application
The National Blood Clot Alliance (NBCA) is pleased to announce that we have
been selected to participate in the 2017 TCS New York City Marathon’s Charity
Program. Now in our 6th year as a Community Level Charity, NBCA will have a
minimum of five guaranteed entries into the November 5th Marathon. This
Marathon is the premier event of New York Road Runners, and one of the world’s
greatest road races, drawing more than 100,000 applicants annually.
Applications are now being accepted for Team Stop The Clot®. Each accepted
team member will be expected to raise a minimum of $2500. We’re pleased to provide Team Stop The Clot® members with
special amenities including: A Stop The Clot® racing singlet, a race weekend dinner, fundraising assistance and weekly live
chat Facebook training advice through NYRR. Additionally, our Team Stop The Clot® Facebook page offers guidance and
camaraderie from past marathoners and endurance athletes.
Please complete the application below and email it to [email protected] or fax it to 781.784.5531. Applications will be
processed in order of receipt. You will be notified of your acceptance to Team Stop The Clot® within 2 weeks of receipt of
your completed application.
Name: ______________________________________________________________________________________
Street: ______________________________________________________________________________________
City:
_____________________________________________ State: ______________ Zip:______________
Phone: (h) _________________________ (c) _________________________ (w) _________________________
E-Mail: ______________________________________________________________________________________
Gender: _________________________
Date of Birth (month/date/year) _________________________
Employer: ____________________________________________________________________________________
I will make every effort to raise a minimum of $2500 according to the following schedule:
$1000 raised by July 15, 2017
$2500 minimum raised by October 2, 2017
I understand, however, if the minimum is not raised by October 2, 2017my credit card may be charged to meet the balance
due to reach NBCA’s minimum fundraising requirement of $2500. Runner participation is contingent upon meeting the charity’s
fundraising commitment. Ensuring that minimums are being met is a part of our contract with NYRR. (see page 3).
Please note that in addition to the fundraising minimum, Team Stop The Clot® members are required to pay the event entry
fees to the TCS New York City Marathon
I acknowledge having read and will abide by the portions of the TCS New York City Marathon Charity Program Agreement of
relevance to Team Stop The Clot® Runners, on page 3 of this application.
Signature
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Name on Credit Card
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MC, Visa, AMEX
__________________
Credit Card #
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Expiration Date____________
Security Code _____
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2017 TCS New York City Marathon / Team Stop The Clot® Application
How did you hear about Team Stop The Clot®? ____________________________________________________________
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Why do you wish to join Team Stop The Clot®. _____________________________________________________________
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Do you have a special interest in blood clots or clotting disorders? Will you be running in honor or in memory of someone
you know?__________________________________________________________________________________________
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Have you ever fundraised for a charity event before? If so, please indicate how much you raised, and describe how you
succeeded. ________________________________________________________________________________________
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Are you involved in your community or with other charitable organizations?_______________.________________________
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What is your personal fundraising goal? While the minimum fundraising requirement for members of Team Stop The Clot®
is $2500, additional consideration will be given to runners who are willing to make a more aggressive fundraising
commitment (in past years, runners accepted to our Team committed to $3,000 - $10,000+). The minimum fundraising goal
for Team members who have obtained an official entry from another source is $750.
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2017 TCS New York City Marathon / Team Stop The Clot® Application
How do you plan to reach your fundraising goal? Please list 3 activities and estimate how much you anticipate raising from
those efforts. ________________________________________________________________________________________
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Does your employer have a Matching Gift Program? If so, do you plan to use Matching Gift funds to reach your fundraising
minimum or do you plan to utilize the funds to exceed your fundraising minimum?
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What prior race experience do you have? Please include information on the number of half and full marathons you have
completed._________________________________________________________________________________________
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Do you know someone who has a number from another source and may be interested in joining Team Stop The Clot®? If
so, please provide their contact information so we can tell them about the Team. The minimum fundraising goal for Team
members who have obtained an official entry from another source is $750.
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TCS NEW YORK CITY MARATHON
Portions of Charity Program Agreement of Relevance to Runners
2D
3A
4A
4D
5C
The Charity must establish a minimum amount of at least $2500 that a recruited Entrant, will donate / fundraise on
behalf of the Charity.
The (Charity Entry) fee is $450 per Entry. NYRR will not refund Charity for any unused Entries
The Charity must use any or all of its Entries by the registration deadline of September 14, 2017 such that all Entrants
must register on or before that day. No exceptions will be made to register an Entrant after this deadline.
Entries are non-transferable and non-deferrable.
Each Entrant must pay NYRR event fees that are not covered by the Charity.
The 2017 fee is $255 for NYRR members and $295 for non-members. The fee for Non U.S. Residents (including
Puerto Rico and other U.S territories) is $295.
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