2021 TCS City / Team Stop The Clot® Application The National Blood Clot Alliance (NBCA) is pleased to announce that we have been selected to participate in the 2021 TCS Marathon’s Charity Program. Now in our 10th year as a Community Level Charity, NBCA will have a minimum of ten guaranteed entries into the November 7th Marathon. This Marathon is the premier event of , and one of the world’s greatest road races, drawing more than 100,000 applicants annually.

Applications are now being accepted for Team Stop the Clot®. Each accepted team member will be expected to raise a minimum of $5,000. We’re pleased to provide Team Stop the Clot® members with special amenities including: A Stop the Clot® racing singlet, a race weekend brunch, fundraising assistance and weekly live chat Facebook training advice through NYRR. Additionally, our Team Stop the Clot® social media pages offer guidance and camaraderie from past marathoners and endurance athletes.

Please complete the application below and email it to [email protected]. Applications will be processed in order of receipt. You will be notified of your acceptance to Team Stop the Clot® within 2 weeks of receipt of your completed application.

Name: ______Street: ______City: ______State: ______Zip:______Phone: (h) ______(c) ______(w) ______E-Mail: ______Gender: ______Date of Birth (month/date/year) ______Employer: ______

I will make every effort to raise a minimum of $5,000 according to the following schedule: $2,500 raised by August 1, 2021 $5,000 minimum raised by October 17, 2021

I understand, however, if the minimum is not raised by October 17, 2021 my credit card may be charged to meet the balance due to reach NBCA’s minimum fundraising requirement of $5,000. Runner participation is contingent upon meeting the charity’s fundraising commitment. Ensuring that minimums are being met is a part of our contract with NYRR. (see page 3).

Please note that in addition to the fundraising minimum, Team Stop the Clot® members are required to pay the event entry fees to the TCS New York City Marathon ($255 for NYRR members and $295 for non-members).

I acknowledge having read and will abide by the portions of the TCS New York City Marathon Charity Program Agreement of relevance to Team Stop the Clot® Runners, on page 3 of this application.

Signature ______Name on Credit Card ______MC, Visa, AMEX ______Expiration Date______Security Code _____ Credit Card # ______Page 1 of 3

2021 TCS New York City Marathon / Team Stop the Clot® Application

How did you hear about Team Stop the Clot®? ______

Why do you wish to join Team Stop The Clot®. ______

Do you have a special interest in blood clots or clotting disorders? Will you be running in honor or in memory of someone you know?______

Have you ever fundraised for a charity event before? If so, please indicate how much you raised, and describe how you succeeded. ______

Are you involved in your community or with other charitable organizations? ______

What is your personal fundraising goal? While the minimum fundraising requirement for members of Team Stop the Clot® is $5,000, additional consideration will be given to runners who are willing to make a more aggressive fundraising commitment (in past years, runners accepted to our Team committed to $5,000 - $10,000+). ______

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2021 TCS New York City Marathon / Team Stop the Clot® Application

How do you plan to reach your fundraising goal? Please list 3 activities and estimate how much you anticipate raising from those efforts. ______

Does your employer have a Matching Gift Program? If so, do you plan to use Matching Gift funds to reach your fundraising minimum or do you plan to utilize the funds to exceed your fundraising minimum? ______

What prior race experience do you have? Please include information on the number of half and full you have completed. ______

Do you know someone who has a number from another source and may be interested in joining Team Stop the Clot®? If so, please provide their contact information so we can tell them about the Team. The minimum fundraising goal for Team members who have obtained an official entry from another source is $750. ______

TCS NEW YORK CITY MARATHON Portions of Charity Program Agreement of Relevance to Runners

2D The Charity must establish a minimum amount of at least $2500 that a recruited Entrant, will donate / fundraise on behalf of the Charity. 3A The (Charity Entry) fee is $450 per Entry. NYRR will not refund Charity for any unused Entries 4D Entries are non-transferable and non-deferrable. 5C Each Entrant must pay NYRR event fees that are not covered by the Charity. The 2021 fee is $255 for NYRR members and $295 for non-members.

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