Thank you for interest in Team Harlem United for the ING NYC Marathon 2013.
Please fill out the application below. Spaces are limited and applicants will be considered on a first come first served basis. E-mail your application to firstname.lastname@example.org. We will review all applications and notify recipients of spots immediately.
Please note that the guaranteed entry supplied by Harlem United is only the reserved entry. Runners are responsible for the entry fee paid to New York Road Runners.
We seek team members who are dedicated in the quest to raise maximum funds to help save lives.
Please read the following sections carefully before signing below.
By becoming a member of Team Harlem United, you commit to donate or raise funds of at least $3000.00 for the benefit of Harlem United and its community. Your credit card information is required as a guarantee against this commitment. If you have not submitted at least one-half of the minimum committed amount ($500) by October 9, 2013, your credit card will be charged for at least one-half of the minimum committed amount, less any payments received from your donors to date. If an initial credit card charge plus any payments from your donors (including matching corporate gifts) do not total the full minimum commitment ($3000.00), your credit card will be charged on November 1, 2013 for the amount necessary to fulfill that commitment.
You understand that your guaranteed entry and participation in the ING NYC Marathon 2013 is contingent upon this commitment schedule and you accept that if due dates are not met you will be personally responsible for the fundraising minimum. The amount ultimately charged to your credit card will be considered a charitable donation and will send you confirmation of this donation for tax purposes.
Cancellation Policy: You may cancel your participation with Team Harlem United for the ING NYC Marathon 2013, waiving your responsibility of any remaining balance due at any time prior to receipt of your NY Road Runners entry validation number. To do so you must contact Rachel Cutler at Harlem United, in writing, on or before the receipt date of the validation. All money received after that point is nonrefundable as is any donation raised and received by our office. After registration with the ING NYC Marathon 2013, you are responsible for raising your minimum committed amount ($3000.00), even if you are unable to run the half marathon for anyreason, including injury.
Matching Gift Policy: Many companies match employees' charitable contributions. Please 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. If you plan to use matching gift(s) to reach your minimum, it is your responsibility to submit the matching gift form to Harlem United by November 1, 2013.
Thank you for joining TEAM Harlem United. By running in the half marathon, every step you take will help us make a difference in New York City.
This form must be signed and on file with Harlem United Release Form and Contribution Agreement: In consideration for my acceptance onto Team Harlem United, I agree that I will not hold Harlem Unite or any of its affiliates, its employees, volunteers, officers, board members, charities, vendors or sponsors (the "Organization") responsible for any injuries or losses I might incur while participating in the ING NYC Marathon 2013 (the "Marathon") or travel to or from the Marathon or any training sessions or meetings related to my participation in the Marathon (the "Event Activities"). I hereby release and discharge the Organization from any and all claims, demands, damages, and actions, and I voluntarily agree to assume full risk of any and all injuries, damages or losses I may sustain as a result of participation in the Event Activities. I warrant that I have sufficiently trained for the Marathon, and that a licensed physician has verified that I am fit to participate in the Marathon. I grant the Organization permission for the use of my name, likeness, or voice and waive any compensation for said use.
In the Event of an illness, injury or medical emergency: I authorize the Organization 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, ambulance transport serve, and treatment rendered to me including medications and hospitalization. I represent that I have secured adequate insurance again any injury or loss that I might sustain during, or as a result of participating in the Event Activities. The following should be contracted in case of emergency.
EMERGENCY CONTACT: MUST BE COMPLETED
I have read and agree to all the terms and conditions of Team membership.