Champions for CHAM Application

2017 TCS New York City Marathon

Thank you for your interest in joining Champions for CHAM! Please complete and submit the application below to be considered for the team. Following your submission, Montefiore's Office of Development staff will be in touch to discuss the status of your application. Please note that since Champions for CHAM has a limited number of guaranteed entries, completing this application does not guarantee your place on the team. If you have any questions, please email marathon@montefiore.org.

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* 1. Please provide the following information:

First and Last Name

Address (preferred mailing address for receiving marathon materials)

Apt/Unit/Fl #

City/Town

State

ZIP/Postal Code

Email Address (same email you will use for your New York Road Runners account)

Phone Number

Employer

Job Title

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* 2. What is your date of birth?

DOB:

Date

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* 3. I identify my gender as:

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* 4. What is your preferred t-shirt size?

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* 5. Please tell us why you want to be a Champion for CHAM!

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* 6. Do you have past experience with fundraising for a charitable cause?

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* 7. If you have other fundraising experience, please share:

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* 8. How would you meet your fundraising minimum as a member of Champions for CHAM? (Please select all that apply.)

Requesting donations from friends and family via email, mail and other communications channels

Utilizing social media, including Facebook and Instagram, to solicit donations from a broad network of contacts

Holding a fundraising event and donating the proceeds to my campaign

Making a personal donation to cover my fundraising minimum

Requesting a donation from my employer

Soliciting matching gifts from my donors

Other (please specify)

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* 9. Do you have a My NYRR account with New York Road Runners?

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* 10. How many half marathons have you completed?

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* 11. How many marathons have you completed?

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* 12. How many times have you completed the New York City Marathon?

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* 13. Do you have a credit card that expires after November 30, 2017? This card is required to set up your fundraising page.

Yes

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* 14. Please review the following terms and conditions and indicate if you agree to them by selecting 'yes' or 'no' below.

Members of Champions for CHAM are required to pay for their own TCS New York City Marathon entry fee.

As a member of Champions for CHAM, you are required to fundraise at least $3,000 by 11:59PM on race day, November 5, 2017. You agree to be personally responsible for making any additional donations necessary to meet your pledge by the deadline regardless of injury or other unforeseen event.

You will meet an interim fundraising goal of $1,000 by August 15, 2017 or risk losing your TCS New York City Marathon guaranteed entry.

Yes, I agree to these terms and conditions.

No, I do not agree to these terms and conditions.