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									 Boys & Girls Clubs of Dorchester’s 2013 Boston Marathon® Program Application
                    117th Boston Marathon - April 15, 2013
           Thank you for your interest in joining Boys & Girls Clubs of Dorchester’s Marathon Team.
 This is your chance to participate in the world’s oldest annual marathon while making a difference in the lives
                                              of thousands of youth.

                           Application must be submitted by October 31, 2012.
Incomplete applications will not be accepted. If we have not filled all spots by October 31, we will continue to
                                  accept applications until all spots are filled.

Marathon Program
Boys & Girls Clubs of Dorchester (BGCD) is proud to be part of the Official B.A.A. Boston Marathon Charity
Program, with 15 entries for the 2013 Boston Marathon. These entries give runners who were ineligible or
unable to obtain a qualifying timed entry for the Boston Marathon through B.A.A. an opportunity to participate.
In addition to these 15 invitational entries, our BGCD team welcomes qualified runners who have secured their
own entry from the B.A.A. and are already entered into the 2013 B.A.A. Boston Marathon.

Benefits of becoming a member of Boys & Girls Clubs of Dorchester’s 2013 Marathon Team:
    Participate in the world-famous Boston Marathon
    Join a running group, specifically designed for non-profit team members, and receive coaching, , advice
       from experienced runners, weekly practice runs, events and an organized training schedule for the
       marathon
    Have your own fundraising webpage and access to fundraising training, support and tips to be successful
    Special discount at local sports store
    Social gatherings and periodic meetings with teammates
    Team apparel

   Most importantly you’ll have the opportunity to make a difference in the lives of 4,000+ youth who call the
   Boys & Girls Clubs of Dorchester their home away from home. We will invite all team members to our
   Clubs for a tour and kickoff meeting. You will see firsthand our facilities and the children who thrive in our
   various programs including athletics, education, arts, music, childcare and more that you will be raising
   money for.

Team Members must:
    Raise a minimum of $4,000 for Boys & Girls Clubs of Dorchester (or $750 for qualified runners who
     have secured their own entry from the B.A.A. and are already entered into the 2013 B.A.A. Boston
     Marathon.)
    Pay a $35 non-refundable application fee
    Pay a $100 non- refundable deposit to cover the Boston Marathon Charity Program Invitational Entry
     Fee
    Pay a $300 non-refundable registration fee to the Boston Athletic Association
    Be 18 years or older before April 15, 2013
    Be capable of running a marathon in less than six (6) hours
                  Boys & Girls Clubs of Dorchester’s 2013 Marathon Team Application
                                               -
            117th BOSTON MARATHON                  Monday, April 15, 2013 - DISTANCE: 26 miles, 385 yards


First Name:

Last Name:

Gender:

Age as of April 15, 2013:

Address:

City:                       State:          Zip:

Primary Phone:

Employer:                                      Title:

Work Address:

City:                     State:           Zip:

Work Phone:                  Fax:

Primary Email Address:

Send mail to:     Work Address       Home Address




Fundraising Experience

Have you ever participated in a sporting event (marathon, bike ride, road race, walk) charity program before?
    YES         NO
         If so, which charity?
         How much money did you raise?
What is your goal for this year’s Boys & Girls Clubs of Dorchester Marathon Program? (Minimum $4,000) $

Does your employer have an Employee Matching Program for charitable giving?              YES          NO

Marathon History/ Running Experience

My running level:     Beginner          Intermediate           Advanced
Current weekly running mileage: ___________             Typical training pace (minutes per mile)_______________
Have you run a marathon before?          YES              NO      If so, how many?
Where?                                             When?                                        Best time:
Other races you have participated in:
Additional Information
We anticipate a high number of applicants for the 2013 Boys & Girls Clubs of Dorchester’s Marathon Team and are
looking to form a team of motivated, enthusiastic runners who want to be personally involved in team meetings and will
surpass the fundraising minimum.

Describe why you would like to run for Boys & Girls Clubs of Dorchester (minimum 200 words):




List any volunteer support you could provide Boys & Girls Clubs of Dorchester (i.e. tutor, coach, website design, computer
support, etc.) and how you see yourself being involved in the organization after the marathon.




Have you had experience with other charity programs? If yes, please describe.




Describe your ideas for fundraising - how will you meet and exceed your fundraising goal? Please provide a breakdown
of your anticipated donations (example: $1,000 from family, $500 from colleagues, $1,500 from fundraising event,
etc.).




What other organizations are you involved with?




BGCD will hold monthly meetings for group training and planning. Do you foresee any conflicts in attending these
meetings? If yes, please explain.




A note about myself (best run ever, anything unique, a personal story, obstacles overcome, etc.).




T-shirt Size:   Men’s       Women’s /           Small     Medium   Large   XL      XXL

Singlet Size (tank top style running jersey):     Men’s       Women’s /    Small    Medium     Large     XL    XXL
Terms and Conditions:

PLEASE READ CAREFULLY: Upon acceptance onto the Boys & Girls Clubs of Dorchester’s 2013 Marathon Team,
each member is required to raise a minimum of $4,000 to help support the positive, life-changing work of Boys & Girls
Clubs of Dorchester. A non-refundable $100 deposit will be required at the time of acceptance onto the team. This $100
fee will cover your B.A.A. Boston Marathon Charity Program Invitational Entry Fee and will not be applied to your
minimum. We ask that you meet the following financial due dates: $1,500 on or before January 25, 2013; an additional
$1,500 on or before March 8, 2012; and the final balance on or before April 8, 2013. All funds must be raised,
collected by participants and received prior to each deadline listed above.

I have read the above guidelines and I hereby guarantee that I will raise $4,000 for the Boys & Girls Clubs of Dorchester
Boston Marathon Program. Should I be unable to meet this goal for any reason, Boys & Girls Clubs of Dorchester has my
permission to charge the remaining balance to my:

   MasterCard       Visa       American Express

Card Holder’s Name                                         Card Holder’s Signature________________________________

Card Number

 Exp. Date

Billing addresss (if different from home address above):

City:                      State:          Zip:


Cancellation Policy: Once you are offered a spot on the team, you will be considered a team member. This spot will only
be held for three days. You may cancel your spot on the team on or before December 31, 2012. To cancel, you must
contact Heather Brigham at BGCD in writing. Any fees or donations received during this time, including the $100 depsoit,
will not be refunded. After December 31, 2012, you are responsible for raising your $4,000 minimum, even if, for any
reason, including injury, you are unable to participate in the Marathon.

Matching Gift Policy: Many companies match employee charitable contributions. You can check with your employer to
see if your company has this program, and ask donors if their employers match gifts. Many companies issue matching gift
checks quarterly or semi-annually; therefore if you plan to use a match to reach your minimum, it is your responsibility to
contact the matching company to ensure that the check will be issued before April 8, 2013. It is your responsibility to let us
know of any paperwork that we may need to provide the company who is matching the gift in a timely manner so that you
can meet the April 8, 2013 deadline for matching gifts.
B.A.A. Boston Marathon Entry Fee: BGCD will inform you of the details of the B.A.A. registration after you have been
selected onto the team. The B.A.A. charges a $300 race entry fee that does not count toward your fundraising
commitment. This fee will be collected separately at a later date (early 2013). You should NOT contact the B.A.A. directly
to secure your entry.
Release Form and Contribution Agreement: In consideration of my accepting this entry, I hereby for myself, my heirs,
my executors, and administrators, waive and release any and all rights for claims and damages I may have against Boys
& Girls Clubs of Dorchester, 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 preceding. I further
attest and certify that I am physically fit and have sufficiently trained for competition in this event, and a license medical
doctor has verified my physical condition. I also grant permission for the 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 $4,000 for Boys & Girls Clubs of Dorchester by April 8, 2013. If I have not reached the minimum in
sponsorships by this date, I will personally be responsible for the balance owed. I understand that unless I cancel by
December 31, 2013, Boys & Girls Clubs of Dorchester reserves the right to charge the balance I owe to my credit card. I
declare that the decision to sign this agreement was voluntary and not based on influence by any representative of Boys
& Girls Clubs of Dorchester.

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 Boys & Girls Clubs of Dorchester 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 and treatment rendered to me including but not limited to medical
transport, medications, treatment, and hospitalization. The following person should be contacted in the event of an
emergency:
Name                                               Relationship
Phone Number
Allergies to Medication
To pay the non-refundable $35 application fee:

   Please charge my credit card:

           Please use the same card listed above.

          MasterCard        Visa      American Express     Card Holder’s Name

       Card Number                                 Exp. Date

    I understand that after December 31, 2012, I am solely responsible for raising or personally donating $4,000
to Boys & Girls Clubs of Dorchester, even if, for any reason, including injury, I am unable to participate in the
marathon.
  I agree to all terms and conditions of this program.

Signature of applicant:_____________________________________ Date:____________


                                 For more information or to submit your application:
                                                   Heather Brigham
                    Boys & Girls Clubs of Dorchester, 1135 Dorchester Ave., Dorchester, MA 02125
                    Phone: 617-288-7120 Fax: 617-288-8221 Email: marathon@bgcdorchester.org

								
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