Champions for CHAM Application 2019

2019 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 Champions for CHAM has a limited number of guaranteed entries and completing this application does not guarantee your place on the team. If chosen, Montefiore will cover your registration fee, and all we ask is that you fundraise a minimum of $3,500 for CHAM. We will coach you towards this goal! If you have any questions, please email msmith2@montefiore.org.

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* 1. Please provide the following information:

First and Last Name *

Employer / Job Title (if applicable) *

Address (preferred mailing address for receiving marathon materials) *

Apt/Unit/Fl #

City/Town *

State *

ZIP/Postal Code *

Country

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

Phone Number *

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* 2. What is your date of birth?

Date of Birth (MM/DD/YYYY):

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, 2019? 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.

As a member of Champions for CHAM, you agree to raise a minimum of $3,500 by 11:59PM November 30, 2019.

You agree to be personally responsible for making any additional donations necessary to meet your pledge by the deadline regardless of injury, inability to participate in the TCS New York City Marathon, or other unforeseen event.

You grant permission to CHAM to use any photograph, video, or any other record of your participation in the 2018 TCS New York City Marathon, including your name, without remuneration.

You will utilize Crowdrise to solicit online contributions for your fundraising campaign and the Montefiore Office of Development will deposit and process your offline contributions (cash, checks).

Yes, I agree to these terms and conditions.

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