Are you a runner and interested in a guaranteed spot in the

world-renowned TCS New York City Marathon on November 5, 2017?

The American Heart Association/American Stroke Association is proud to be a part of the NYRR Charity Partner Program. We have a limited number of guaranteed entries to this year’s race. In exchange for a guaranteed entry to this year’s marathon through the American Heart Association, recipients will commit to raising funds to support our life saving work.

The American Heart Association/American Stroke Association is dedicated to reducing disability and death from heart disease and stroke. These diseases, America’s No. 1 and No. 5 killers, claim over801,000 lives a year. The Association funds research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives.

Frequently Asked Questions about the TCS NYC Marathon Charity Partner Program

How much money do I have to raise?

Runners are required to raise a minimum of $3,500 to participate. If you do not reach the $3,500 goal, you will be required to donate the difference. The American Heart Association will provide you with tools and resources to help with fundraising.

Where do I send my application?

Completed applications should be faxed to (212) 878-5970 or emailed to . You may also mail your application to the American Heart Association, TCS NYC Marathon, 122 East 42nd Street – 18th Floor, New York, NY 10168.

What is the deadline to submit myapplication to the American Heart Association?

The deadline to apply for the American Heart Association team is June 30th. (Spots are filled on a first-come, first-served basis.)

If I am accepted, when will I be notified?

Selected applicants to the American Heart Association/American Stroke Association Charity Partner Team will be notified within one week of application by email. You must complete your registration on the NYRR site and pay the NYRR registration fee by September 14th in order to confirm your entry.

How will the American Heart Association use the funds that I raise?

Heart disease and stroke are the Nation’s #1 and #5 causes of death. Money raised will help us build healthier lives through research, advocacy, education, and quality care initiatives.

For additional information, please contact Desiree Cooper at (212) 878-5924 or .

TCS New York City Marathon Charity Partner Commitment Form

Please complete the following information and fax toDesiree Cooper at (212) 878-5970 or email to .

Name ______

Address ______

City ______State ______Zip ______

Daytime Phone (____) ______Cell Phone (____) ______

Email______Age ______Gender______

Have you applied to the TCS New York City Marathon non-guaranteed entry drawing?  Yes  No

If yes, what is your number? ______

Is this your first time running a marathon?  Yes  No

Is this your first time running for the AHA?  Yes  No

Are you a heart disease/stroke survivor?  Yes  No

Why do you want to join the AHA Team?______

Running Singlet (Tank): (Women’s Cut or Men’s Cut)? ______

Running Singlet (Tank) Size: (S, M, L, XL, XXL)? ______

The American Heart Association will be providing transportation to the start line on marathon day. The bus will leave the American Heart Association (122 East 42nd Street, New York, NY 10168) promptly at 5:30 a.m. Would you like to utilize this transportation (yes or no)? ______

TCS New York City Marathon Charity Partner Commitment Form Continued…

In exchange for a marathon entry, participants must pledge to raise a minimum of $3,500 to support the lifesaving work of the American Heart Association/American Stroke Association in the fight against heart disease and stroke.

You are required to raise the $3,500 minimum by Friday, October 27, 2017. If you have not fulfilled your fundraising commitment by the deadline, the balance will be charged to your credit card, otherwise you will not be permitted to participate in the race. All donations are non-refundable.

Charity Partner entries can only be deferred to 2018 if the total fundraising commitment has been fulfilled. November 1stis the last day to defer.

If you withdraw from the teamfor any reason and the AHA is unable to fill your spot, you will be charged $575 to cover the cost of participation as a NYRR Charity Partner team member. You must notify the American Heart Association to officially withdraw from the race, otherwise you will be heldresponsible for $3,500.

Credit Card Type  Visa  Master Card  American Express Discover

Name on Credit Card ______

Credit Card Number ______

Billing Address______

Billing City______Billing State______Billing Zip ______

Expiration Date ______

I agree to the above terms. I would like to receive an entry into the 2017 TCS NYC Marathon and commit to the $3500 fundraising minimum with full understanding that if I withdraw for any reason I will have to cover the $575 cost of participation if my spot cannot be filled. I understand that I must notify the American Heart Association to officially withdraw from the race, otherwise I will be held responsible for $3,500.

Print Name ______Date ______

Signature ______

IMPORTANT: Please read this statement and initial below

Please be aware that AHA cannot accept payments for your financial commitment under this agreement from a Donor Advised Fund. The IRS provides that payment by a Donor Advised Fund of a donor’s legal obligation to another is not allowed.

______I do not plan to pay using Donor Advised Funds

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