SUNDAY, MARCH 20, 2016

Thank you for your interest in joining Team MCC!

A limited number of guaranteed entries to the NYC Half are available and we would love to have you on our team. To be considered for an entry, each runner must commit to make a donation or raise funds totaling $1,500 or more to the Manhattan Childrens Center.

Please note that this form does not guarantee your entry. If you are selected to run, you will receive notification no later than January 6, 2016.

General Information

First & Last Name: _________________________________________________________________

Address: _________________________________________________________________________

Phone Number: _________________________________Date of Birth: ______________________

Email: ___________________________________________________________________________

Fundraising Goals

By joining Team MCC and receiving guaranteed race entry, you are committing to raising at least $1,500, due not later than 2 weeks after the race, or April 6, 2016. We encourage all charity runners to set a fundraising goal above this minimum. We'll help you set up with an easy-to-use online fundraising tool.

What is your Fundraising Goal? $______________

Payment Information

All charity runners must guarantee the $1,500 fundraising minimum with a credit card. If you have raised less than $500 by March 11, 2016, two weeks before the race, we will charge your credit card an amount equal to $500 less the amount raised. The full $1,500 donation minimum must be met by April 6, 2016, two weeks after the race. The amount charged will equal $1,500 less the amount raised. If you join the team but drop out after February 18, 2016, you will be charged $1,500 less the amount raised.

Type of Card: ☐ Visa ☐ MC ☐ AMEX

Account Number: ________________________________________________________

Exp Date: ______________ Name on Card: ____________________________________

Signature: ______________________________________________________________

Please return this form to Amanda Nason

anason@manhattanchildrenscenter.org

Questions? Call 212-749-4604