2016 Boston Marathon Wediko Team Application Overview

Transcription

1 2016 Boston Marathon Wediko Team Application Overview Thank you for taking the time to complete this application. Wediko Children s Services believes children s mental health matters and that children do best when all of the adults in their life are working together. On behalf of the children, families, and schools served by Wediko, we thank you for considering making a difference and joining our team. We are looking forward to a successful and exciting marathon training season! Wediko has supported a Boston Marathon team since We believe this opportunity truly enhances the Boston Marathon experience. As a member of Team Wediko you will share great comradery with your fellow team members, benefit from coaching and fundraising support, and enjoy weekly team long runs. All while supporting at risk and under-served children and families. To be considered for selection to the 2016 Wediko Boston Marathon team, please mail, fax, or scan your completed application to the address below. While the team is chosen on a rolling basis, please submit by November 20, All applicants will be notified by December 7, 2015 of their status. Send complete applications to: Kate Regal Wediko Children s Services E. Dedham St. Boston, MA Fax: kregal@wediko.org Important Dates & Milestones! Completed Applications ASAP and no later than November 20, 2015 Notification of Team Assignment Rolling, no later than December 7, 2015 $100 deposit due to reserve your spot! December 11, 2015 (official team members Deadline to withdraw from team and avoid fundraising requirement. only) December 18, 2015 (Noon, EST) $2500 Fundraising Milestone Due February 1, 2016 $5000 Fundraising Milestone Due March 1, 2016 $7500 Fundraising Milestone Due April 1, 2016 Running of the 120 th Boston Marathon!! April 18,

2 Benefits of being a member of the Wediko Marathon Team: Guaranteed race entry for the 120 th Boston Marathon on April 18, 2016 Connect with a team of runners who are committed to training for a marathon and raising money to support Wediko Receive weekly coaching and fundraising support from the Wediko coach who has run Boston 13 times and raised over $160,000 for charity Weekly team training runs (many held on the Boston Marathon course) Fundraising handbook with strategies to assist you in raising money Online fundraising Wediko Marathon Team running singlet, pre-race pasta lunch, and post-marathon gathering The knowledge that the miles you train and the race you run makes a difference for children and families struggling with issues related to mental health and learning challenges. Responsibilities of being a member of the Wediko Marathon Team: $350 race entry fee. (This f.ee is payable to the B.A.A. and is not part of the fundraising commitment. This fee is due in January.) Commit to raise a minimum of $7500 to support Wediko Children s Services by 4/1/16. Be physically able to complete the marathon in under 6 hours. If you are local to Boston, attend Wediko Marathon Team meetings between December 2015 and April Participate in monthly fundraising conference call Wear Wediko Team singlet in 2016 Boston Marathon 2

3 Wediko Boston Marathon Charity Team Application Last Name First Name MI Street Address City State Zip Address Home Phone Cell Phone Work I prefer to be contacted at Home Work Cell Employer Title Does your company have a Matching Gift program? Yes No Gender : M F DOB: / / T-shirt Size: Singlet Size: We would like to know more about you. (Add another page if necessary) Please tell us about: Running Experience: Have you run a marathon before? Yes No How many marathons? Have you run the Boston Marathon before? Yes No How many times?/when? Fastest Marathon time: Have you run a half-marathon before? Yes No How many? Average pace? Fundraising Experience: Have you ever raised significant funds for a program/charity before? Yes No If yes, for which charity and how much money did you raise? Charity Name/Event Year: Amount raised: $ Charity Name/Event Year: Amount raised: $ Charity Name/Event Year: Amount raised: $ 3

4 What will be your fundraising goal for the 2016 Wediko Marathon Team? $ How do you plan to raise these funds? (Please be as detailed as you can be about your plan) Interest in Joining the Wediko Marathon Team: How did you learn about the Wediko Marathon Team? Why are you interested in running for Wediko? What other community organizations are you involved with? 4

5 Wediko Children s Services Terms and Conditions Application Process: Once you have submitted your application, Wediko Children s Services may contact you by phone to discuss your application. Your selection to be a member of the Wediko team will be conditioned on a number of factors, including your completed application and fundraising commitment. Once you accept a position on the team, Wediko will collect $100 deposit to secure your spot. This deposit is part of your fundraising total and counted towards your commitment. It is non-refundable if you cancel your participation. Cancellation Policy: Prior to December 18, 2015 (at noon, EST), you may cancel your participation with the Wediko Boston Marathon team and waive your fundraising requirement. To cancel, you must contact Kate Regal in writing on or before December 18, Your $100 deposit and any donations received by our office are non-refundable. There is no cancellation after December 18, If for any reason you are unable to run the marathon (injury, work commitment, family or other emergency, etc.), you remain responsible for the $7500 fundraising commitment. Again, donations received by our office are not refundable. Fundraising Commitment: When you join the Wediko Boston Marathon team, you commit to a fundraising requirement of $7500. We hope you will be extremely successfully and surpass this minimum! However, should you fall short, your credit card will be charged the difference on each milestone date listed below. We will reimburse your card upon written request once you meet the minimum. After May 15, 2016 we will no longer reimburse you/your card. Fundraising Milestone Due Date $100 December 11, 2015 $2500 February 1, 2016 $5000 March 1, 2016 $7500 April 1, 2016 Qualified Entrants: Wediko welcomes qualified entrants and other official entrants to join the 2016 Wediko Marathon Team. While there is no fundraising minimum, we suggest a goal of $1000. Qualified entrants will be invited to all group runs, pre-marathon pasta luncheon, post-race gathering, and other team events. Qualified entrants are responsible for their own race registration. Matching Gift Policy: Many companies match employees charitable contributions. You can check with your employer to see if your company has this program. We suggest you ask all of your donors if their employers match gifts. As matching gifts are disbursed at different intervals, it is your responsibility to contact the matching company to ensure the check will be issued by April 1,

6 Release Form and Contribution Agreement: In consideration of my joining the Wediko marathon team, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights for claims and damages I may have against Wediko Children s Services, its employees, volunteers, officers, and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event, or travel to or from any of the proceeding. I further attest and certify that I am physically fit and have sufficiently trained for competition in this event, and a licensed medical doctor has verified my physical condition. I also grant permission for use of my name and or photograph or voice in broadcast, telecast, print, or any other account of this event and agree to waive any compensation for such use. I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement was voluntary and not based on or influenced by any representation of Wediko Children s Services. In the event of an illness, injury, or medical emergency arising during the event or in the training and planning sessions for said event, I hereby authorize and give my consent to Wediko Children s Services 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 medical services and treatment rendered to me including but not limited to medical transport, medications, treatment, and hospitalization. I am applying to be a member of the 2016 Wediko Marathon Team and hereby accept and agree to the terms and conditions set forth in these Terms and Conditions. Signature: Date: Print Name: Emergency Information: The following person should be contacted in the event of an emergency: Name: Relationship: Telephone Number(s): H: C: W: address: Allergies to Medications: Other relevant medical information: 6

7 Please provide your Credit Card Information: (credit card must have an expiration date later than May 2016 to be valid) *If a spot on the Wediko Marathon team is offered and accepted, a non-refundable deposit of $100 will be charged to hold your spot. This $100 is part of your fundraising commitment. Your card will then only be used if a fundraising milestone is not met (see pg. 1).. Type of card: MasterCard Visa Discover American Express Name on card: Card Number: Expiration date: Security Code: address: Billing Address: Signature of card holder: Thanks again for your interest in running for Wediko and raising much needed funding! We appreciate the time you took to fill out our application. We will confirm receipt of your application within 48 hours. In the meantime, please notify us of any changes to your application, including a change in interest. Good Luck! Submit completed application to: Kate Regal Wediko Children s Services E. Dedham St. Boston, MA Fax: kregal@wediko.org 7