Please Choose One*Charity RunnerRegistered Qualified Runner/Invitational Entry(In 2018, the average raised per Boston Marathon Team JAF runner was over $11,000.) Charity Runner - I DO need guaranteed entry through Team JAF (fundraising commitment minimum of $8500) Registered Qualified Runner / Invitational Entry - I DO NOT need an entry but wish to fundraise as part of Team JAF (fundraising commitment minimum of $2000)First Name*Last Name*Address*City*State*[select one]AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code*Date of Birth*Home Phone*Cell Phone*Employer*Title*Email Address* Are you in need of any special assistance or are you applying for participation in the disability or visually impaired division?*YesNoIf yes, please explain: Does your company have a matching gifts program?*YesNoNote: Matching gifts do not count towards your minimum fundraising.SizesWe do not guarantee to provide all items, beyond the official Team JAF singlet, but you may be able to purchase the items separately.Singlet (typically run small)*Jacket*Pants*Fundraising ExperienceHave you participated in a road race charity program before?*YesNo If yes, what is the most recent race/charity for which you raised funds, and how much money did you raise?Please list any other charity fundraising programs in which you participated (name, year and amount required):What will your fundraising goal be for Team JAF? (minimum is $8,500)What are your ideas for raising these funds? Please be specific. (You may email additional information to Tracey Mahoney at email@example.com).*If you are you on Facebook, what is your Facebook name?If you are you on Twitter, what is your Twitter handle?If you are you on Instagram, what is your username?Are you affiliated with the Joe Andruzzi Foundation in any way (ie: corporate member, board member, volunteer, staff, relative or friend of someone working at JAF, etc.)?*YesNo If yes, how?How did you find out about running the Boston Marathon® for Team JAF?*Please Select OneI ran for Team JAF in previous Boston Marathon(s)I ran for Team JAF in other races (not Boston Marathon)John Hancock Non-Profits Marathon Program websiteCharityTeams.org website or social media site(s)Joe Andruzzi Foundation e-blastJoe Andruzzi Foundation social mediaJoe Andruzzi Foundation websiteOnline searchWord of mouthOtherIf other, please explain:Please describe why you would like to run for the Joe Andruzzi Foundation?*If selected, would you be willing to potentially share your story via social or traditional media outlets?*YesNoRunners are invited to attend CharityTeams monthly meetings in Boston, weekly long runs on Saturday mornings outside of Boston and Tuesday night hill workouts in Newton. Do you foresee any conflicts in attending the meetings or runs? We want to ensure all our runners have access to proper training*I acknowledge(Note: Attendance at monthly meetings is very important unless you are an out of state runner.)Running ExperienceWhat is the average number of miles per week that you have run during the past few months?*Have you ever participated in a road race before?*YesNoHave you ever completed a marathon before?*YesNo If yes, please list the date(s) and time(s) it took you to complete (starting with the most recent).If selected, would this be your first Boston Marathon?*YesNo If no, how many Boston Marathons have you run and what was the most recent date?Do you currently belong to a running club?*YesNo If yes, which one?Terms & ConditionsRegistration: You will receive your race registration after your application is accepted and you are confirmed onto our team. The Boston Athletic Association charges a $365 race application fee that is the sole responsibility of the team member. This fee does not count toward your fundraising commitment. The registration fee will be collected separately and specific instructions will be provided when registration links become available. All Boston Marathon® registrations will go directly through Team JAF and CharityTeams. Release Form and Contribution Agreement: In consideration of my accepting this entry, I hereby for myself, my heirs, executors and administrator, waive and release any and all rights for claims and damages I may have against the Joe Andruzzi Foundation and its employees, volunteers, consultants including CharityTeams LLC, Susan Hurley and any coaches and consultants and product sponsors for any and all injuries suffered or sustained by me in said event and in the training and planning sessions for said event or travel to and from any of the preceding. 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 agree 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 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 agree to collect a minimum of $8,500 ($2,000 minimum for own entry) for the Joe Andruzzi Foundation by Thursday, April 11, 2019. If I have not reached the minimum amount in fundraising by that date, I will personally be responsible for the balance owed. I fully understand that unless I cancel by January 1, 2019, the Foundation reserves the right to charge the balance I owe to my credit card. I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement is my own. In the situation of a runner who defaults on this agreement and their credit card is not valid for any reason, the Foundation reserves the right to pursue collection of the debt and the runner will be responsible for any and all legal fees incurred by the Foundation with this collection process. Milestones for fundraising I agree to meet: December 15, 2018 $1,500 minimum; January 15, 2019 $3,000 minimum; February 15, 2019 $4,500 minimum; March 15, 2019 $6,000 minimum; April 11, 2019 $8,500 minimum goal met. By providing my credit card information, I agree that the Joe Andruzzi Foundation may charge my credit card if I fail to meet the fundraising milestones and/or fundraising minimum. I agree to collect a minimum of $8,500 minimum ($2,000 for own entry) for the Joe Andruzzi Foundation by Thursday, April 11, 2019. To ensure these milestones are met, the Joe Andruzzi Foundation reserves the right to charge the difference on your credit card by the date given if we feel there is a failure to fundraise throughout. *ALL RUNNERS MUST RAISE THE MINIMUM FUNDRAISING BY THURSDAY APRIL 11, 2019.* WE DISCOURAGE ANY BIB PICK UP UNTIL THE MINIMUM FUNDRAISING OBLIGATION IS MET. To ensure these milestones are met, the Joe Andruzzi Foundation reserves the right to charge the difference on your credit card by the dates given above if we feel there is a failure to fundraise throughout. Cancellation Policy: Your $50 application fee is non-refundable. You may cancel your participation with the team, waiving your responsibility for the $8,500 minimum ($2,000 minimum for own entry) anytime on or before January 1, 2019. To do so, you must contact Susan Hurley, Program Coordinator via email at CHARITYTEAMS@CHARITYTEAMS.com on or before January 1, 2019. After January 1, 2019 you are still responsible for raising the minimum $8,500 ($2,000 minimum for own entry) even if, for any reason including injury, you are unable to run in the marathon. If you cancel participation after this date, your credit card will be charged the balance of your fundraising commitment. The Joe Andruzzi Foundation has your consent do this. Contributions raised and received by our office will not be refunded, even if you cancel before January 1, 2019.Agree with Cancellation Policy Cancellation Policy Described Above Matching Gift Policy: Many companies match employees’ charitable contributions. Please check with your employer to see if your company has this program, and ask donors if their employer has matching gifts. Matching gifts do not apply to the fundraising minimum but are considered over and above the minimum. It is your responsibility to contact the company to provide all matching gift information and ensure that the gift is processed. I acknowledge that I still need to raise the minimum of $8,500. I agree with Matching Gift Policy 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 the Foundation to secure from an 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 and treatment rendered to me including but not limited to medical transport, medication treatment and hospitalization. I acknowledge and understand. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medication treatment and hospitalization. Emergency Contact(person listed cannot be running the 2019 Boston Marathon)Name*Relationship*Home Phone*Cell Phone*Allergies/ Medications Any other information we should be aware of that may impact your ability to train, finish, or fundraise for this event?*Please electronically sign below relative to the terms and conditions set forth in the above-mentioned contract. No runner will be considered without providing the required documentation. IMPORTANT! Please note regarding the application fee! To complete the registration process, you are required to pay the $50 application fee online. After submitting your application, you will be directed to JAF’s Boston Marathon® Registration Fee page. Should you be accepted to the team, you are required to make a CrowdRise fundraising page on CrowdRise.com (instructions will be given in your Runner Packet). At this time, it will be mandatory for you to input your credit card information. That credit card will remain on file for the duration of your fundraising and will be charged if your fundraising minimum is not met by April 11, 2019. I have received the Joe Andruzzi Foundation Team application and understand all the terms and conditions of my participation in the 2019 program. I am confirming the information listed in this application is accurate. I have also noted the due date for material submission and fundraising goals. I understand that the submission of this application does not guarantee me a spot on the team. Please type your name to certify that you understand and agree to meet all of the terms for the fundraising obligations by Thursday April 11, 2019.Signed*Date* Please type your name to certify your understanding and agreement to the terms and conditions outlined in this application.