2017 TCS New York City Marathon

 

Your Information

*1.  


*2.  


3.
Question - Not Required - Date of Birth:




*4.  


*5.  


*6.  


*7.  


8.  


*9.  


*10.  


 

Employer Information

*11.  


*12.  


*13.  


*14.  


*15.  


*16.


*17.


 

Marathon Charity Experience

*18.


19.  


*20.  


*21.  


*22.

(Maximum response 255 chars, approx. 5 rows of text)

 

Running Experience

*23.


*24.  


*25.


*26.  


*27.  


*28.


 

Health History

*29.

(Maximum response 255 chars, approx. 5 rows of text)

*30.

(Maximum response 255 chars, approx. 5 rows of text)

*31.

(Maximum response 255 chars, approx. 5 rows of text)

 

Background

*32.  


*33.
Question - Required - What is your connection to lupus? (Please check all that apply).

*34.


35.  


36.

(Maximum response 255 chars, approx. 5 rows of text)

 

Emergency Contact:

*37.  


*38.  


*39.  


 

Credit Card Information

*40.  


*41.  


*42.  


*43.
Question - Required - Card Expiration Date:




 

Terms and Condition (terms are below)

 

TEAM LIFE WITHOUT LUPUS TERMS AND CONDITIIONS

Please carefully read the appropriate section below for runners who wish to receive a guaranteed entry into the 2017 TCS New York City Marathon through the Lupus Research Alliance Team Life Without Lupus.

RUNNERS WHO WISH TO RECEIVE A GUARANTEED ENTRY FROM THE LUPUS RESEARCH ALLIANCE

fundraising Commitment: A $3,000 minimum donation is required to join Team Life Without Lupus and receive an invitational entry for the 2017 TCS New York City Marathon. If you are accepted onto the team, you will receive the benefits of team membership which include: a 16-week training program, in person (two times a week) and/or on-line training (if located outside the New York vicinity), a team singlet, complimentary invitation(s) to the team Friends and Family pre-race pasta dinner, team fundraising support, Crowdrise fundraising page access, and race logistics guidance throughout the training program. As a team member, you are required to pay a non-refundable application fee of $15. The application fee will be credited towards your Crowdrise page and reserves a 2017 TCS New York City Marathon invitational entry in your name until Thursday, September 14, 2017 when you must have at least $550 of donations submitted. If you do not have $550 raised by September 14th, 2017 the card on file will be charged to make your fundraising total (at that point) $550. Once you hit the $550 via Crowdrise your card will be reimbursed (the amount we charged to reach $550). The remaining balance must be submitted by December 1, 2017.

A credit card (MasterCard, Visa, or American Express) in your name and valid through January 2018 must be provided upon acceptance for Team Life Without Lupus. On December 1, 2017, the credit card will be billed for any balance due to reach the fundraising minimum of $3,000.

cancellation policy: You may cancel your participation with Team Life Without Lupus for the 2017 TCS New York City Marathon, waiving your responsibility for the $3,000 minimum, any time on or before Friday, September 1st, two weeks before the NYRR registration deadline on September 14, 2017. You must contact the Lupus Research Alliance, in writing, attention Lana Munoz-Abrams, on or before the cancellation date, informing the Organization of your cancellation. The $15 administration fee is non-refundable. After Thursday, September 1st, 2017 you are responsible for raising the $3,000 minimum, even if for any reason, including injury, you are unable to run in the marathon. Only if you are able to find another runner to fill your spot and register with NYRR by or before September 14, 2017 will you be dismissed from the $3,000 fundraising responsibility. Donations raised and received by our office will not be refunded, even if you cancel before the above-stated deadline for cancellation. Moreover, there is no deferment of a place by the New York Road Runners Club. Therefore, if you cancel, any costs paid to the New York Road Runners Club to register for the event will not be re-funded and there will be no ability to use the entry for any future races.

Matching Gift Policy: Many companies match employees' charitable contributions. You can check with your employer to see if your company has this program, and ask your donors if their employers match gifts. Many companies issue matching gift checks quarterly or semi-annually, therefore, it is your responsibility to contact the matching company to ensure the check will be issued before December 1, 2017. If the companies match cycle is past December 2017 the donation may not count toward your minimum.

2017 TCS NEW YORK CITY MARATHON REGISTRATION: The Lupus Research Alliance will inform you of the details of how to receive your official race number after your Team Life Without Lupus team application is accepted. The TCS New York City Marathon charges a Processing Fee of $11 and Entry Fee of $255 for NYRR members, $295 for non-members, & $358 for Non-U.S. residents. These fees do not count toward your fundraising commitment and are your responsibility to pay independently of Team Life Without Lupus.

 

Please fill out the waiver form by clicking the link below.

Waiver Request Form

*44.


*45.


*46.
Question - Required - Submitted on:




 
   Please leave this field empty