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Morgan Memorial Goodwill Industries


Running for Great Kids 2014 Boston Marathon Team Application
Applications will be accepted on a rolling basis.
Send completed applications to:
Morgan Memorial Goodwill Industries
Attention: Erin Flaherty
1010 Harrison Ave.
Boston, MA 02119
Phone: 617-541-1255
Fax: 617-541-1493
Email: eflaherty@goodwillmass.org
Please print clearly
Last Name _____________________________

First Name __________________________

Address _____________________________________________________________________
City ___________________________________

State ____________

Zip ___________

Home/Cell Phone ________________________


Employer ______________________________

Title _______________________________

Work Address ________________________________________________________________


City ___________________________________

State ____________

Work Phone ____________________________

Fax ________________________________

Email Address ______________________________

Date of Birth_____________________

Does your company have matching gifts program?

_____Yes

I would like to be contacted at:

_____Work

_____Home/Cell

Zip ___________

_____No

Fundraising Experience
Have you participated in a marathon/road race charity program before?

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_____Yes

_____No

If yes, for which charity and how much money did you raise?
Charity Name ___________________________

Amount raised: $______________

What will your fundraising goal be for Goodwill?


(minimum required is $4,000) $ ____________
What are your ideas for raising these funds? Please be as specific as possible.
____________________________________________________________________________
____________________________________________________________________________
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____________________________________________________________________________
____________________________________________________________________________
Please answer the following questions so that we can get to know you a little better.
How did you learn about the Goodwill program?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Have you had any experience with Goodwill in Boston or other Goodwill programs?
_____Yes _____No
If yes, how? __________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

What other community organizations are you involved with?


____________________________________________________________________________

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____________________________________________________________________________
____________________________________________________________________________
Have you fundraised for any of these organizations in the past?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Please describe why you would like to run for Goodwill.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
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Goodwill will host a few team meetings before the Marathon. Will you be able to attend these
meetings? _____Yes _____No
If no, what is the reason? ________________________________________________________
Will you attempt to participate in our optional team workouts held bi-weekly?
_____Yes

_____No

If you reside out of state, do you have family, social, or business ties in or around Boston, or
within Massachusetts?

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____________________________________________________________________________
____________________________________________________________________________

Goodwill plans proactive media outreach before and after the Marathon. Will Goodwill have
approval to use your name and/or photo in conjunction with media outreach? If no, why?
____________________________________________________________________________
____________________________________________________________________________

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Morgan Memorial Goodwill Industries Terms and Conditions
for the 2014 Boston Marathon Team
Please read the following carefully before signing below.
Fundraising Commitment: A minimum donation of $4,000 is required to join Goodwills
Marathon Team and receive an individual entry for the 2014 Boston Marathon.
A non-refundable deposit of $100 will be charged to your credit card if you are accepted onto
the team. The $100 will be applied toward your fundraising minimum and reserves a Boston
Marathon number in your name. The remaining balance is due by Friday, May 2, 2014.
Valid credit card information must be included with your application to apply for Goodwills team.
The card must not expire before July 1, 2014. In the event that you do not meet the minimum
donation requirement on May 2, 2014, Goodwill reserves the right to charge the balance owed
to your credit card without notice. MasterCard, Visa and American Express are accepted.
Cancellation Policy: You may cancel your participation with Goodwills team for the Boston
Marathon, waiving your responsibility for the $4,000 minimum anytime on or before January 10,
2014. To do so, you must contact Erin Flaherty, Coordinator of Events and Special Projects at
Goodwill, in writing, on or before the cancellation date. Your $100 deposit fee is non-refundable
and you must forfeit the marathon bib number if you cancel your participation by January 10,
2014. After January 10, 2014, you are responsible for raising the $4,000 minimum, even if for
any reason, including injury, you are unable to run in the Marathon. Your marathon waiver is
non-transferable if you cancel after January 10, 2014.
Donations raised and received by Goodwill cannot be refunded, even if you cancel before
January 10, 2014.
Matching Gift Policy: Many companies match employees 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 the check will be issued before May 2, 2014. If the companys
match cycle is past May 2, 2014, the match cannot count towards your minimum.
Team Members B.A.A. Registration: Goodwill will inform you of the details of the B.A.A.
registration after your application is accepted. The B.A.A. charges a race application fee that
does not count towards your fundraising commitment. Registering with the B.A.A. and paying
the registration fee are your responsibility and must be completed within the deadlines set forth
by the B.A.A.. You should NOT contact the B.A.A. directly to secure your number.
Release Form and Contribution Agreement: In consideration of my accepting this entry, I
hereby for myself, my heirs, executors and administrators, waive and release any and all rights
for claims and damages I may have against Morgan Memorial Goodwill Industries, 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 18 years or older, 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 agree to collect a minimum of $4,000 for Goodwill by May 2, 2014.
If I have not raised the minimum in donations by that date, I will personally be responsible for

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the balance owed. I understand that unless I cancel by January 10, 2014 Goodwill reserves the
right to charge the balance I owe to my credit card after May 2, 2014. 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 representative of
Goodwill.
I agree and understand that I am solely responsible for raising the minimum $4,000 and will be
faithful to my commitment to Goodwill.
Signature: ____________________________________ Date: ___________________
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 Goodwill 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 contact in the event
of an emergency:
Name: _____________________________

Relationship to Runner: ___________________

Telephone Number: ___________________


Allergies to medications: ________________________________________________________
Credit Card Information:
_____MasterCard

_____Visa

_____American Express

Card Number: _______________________

Expiration Date: _________________________

Name on Card:________________________________________________________________
Address (if different from address on page 1): ________________________________________
____________________________________________________________________________
Signature of Card Holder: ______________________

Date: ________________________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - To be completed by Goodwill:

Approved by:
____________________________________________________________________________
Name
____________________________________________________________________________
Signature
____________________________________________________________________________
Date