marathon charity program Information & 2010 Application for non-qualified runners Join Mass. Eye and Ear s marathon team and run the 2010 Boston Marathon.
marathon charity program Mass. Eye and Ear is proud to again be selected as an official charity to receive invitational marathon entries. An invitational entry allows participation in the 2010 Boston Marathon without meeting official time requirements. Mass. Eye and Ear again thanks John Hancock Financial Services, the lead sponsor of the Boston Marathon, for its continuing support of our medical and research mission. Team Eye and Ear members span a wide range of athletic abilities and walks of life. They are generous and dedicated individuals who are athletes, fundraisers and ambassadors for Mass. Eye and Ear. Join the camaraderie of Team Eye and Ear and help advance world renowned research and care for those suffering with loss of vision, hearing, voice, balance or head and neck cancer. Benefits of Becoming a Member of Team Eye and Ear: You will have an opportunity to participate in the world s most famous marathon. You will make a difference in the lives of others. You will enjoy great team kick-off and celebratory events with other Team Eye and Ear runners. You will receive marathon training and coaching through Fitcorp. You will raise money for an important cause! You will receive a fundraising kit that contains a wealth of fundraising ideas and sample letters. You will be able to set up your own personal web site through First Giving, where you can share your story and accept online donations in a secure manner. You will be invited to attend two fundraising workshops where you will get personalized fundraising assistance from professionals. Team Members Must Commit to: Raise a minimum of $3,500 by May 19, 2010 to support Mass. Eye and Ear or pay the balance in full yourself. While the required minimum is set at $3,500 per runner, we are asking that each runner set a personal goal of at least $5,000 to help achieve a team goal of $275,000. Aim high and you will be amazed at what you can raise! Submit a non-refundable $100 deposit and credit card number upon acceptance to the team. This deposit will apply toward your fundraising goal. Pay a BAA race application fee of $250 in addition to the fundraising minimum. Team members must be: 18 years of age or older by April 19, 2010. Capable of running a marathon in less than 6 hours. Qualified Runners Athletes who have met qualification times for the 2010 Boston Marathon and have secured their own entry for the 2010 Boston Marathon are welcome and encouraged to join Team Eye and Ear. Please contact Kristina Sym at (617) 573-6364 or kristina_sym@meei.harvard.edu for more information.
about Mass. Eye and Ear Since our founding in 1824, Mass. Eye and Ear has been guided by a focused mission that the deaf may hear and the blind may see. Today, our vision is to be the preeminent world-wide source of advances and leaders in preserving and restoring vision, hearing, balance and voice and in treating and curing disorders of the head and neck. Patients come to Mass. Eye and Ear for specialized care from Boston, New England, throughout the United States, and from more than 99 countries around the world. Mass. Eye and Ear is the primary teaching hospital of Harvard Medical School in ophthalmology and otolaryngology. Each year, approximately 100 residents and fellows participate in one of the most soughtafter medical training programs in the country. ranking U.S. News & World Report magazine has ranked Mass. Eye and Ear in the top five in one or both of its specialties (ophthalmology and otolaryngology) each year since the magazine began publishing its annual survey of hospitals in 1990. ophthalmology (Eye) Our services range from routine eye exams and laser vision correction surgery to treatment of some the most complex and challenging eye diseases, such as macular degeneration, glaucoma, corneal disease and diabetic eye disorders. In addition to our focus on patient care, Mass. Eye and Ear s team of Harvard physician-scientists are committed to developing new cures and treatments to save and restore vision. otolaryngology (ear, nose, throat, head and neck) Our physicians and audiologists treat problems in a comprehensive range of ENT subspecialties, including: head and neck oncology, voice and speech, ears and hearing, balance, pediatric ENT, facial nerve and thyroid surgery. Our Harvard physician-scientists all conduct clinical research to develop new treatments and cures. Additionally, we are home to the world s largest laboratory conducting basic research in hearing and deafness. Additional information can be found on www.masseyeandear.org
2010 TERMS AND CONDITIONS non-qualified runner Fundraising Commitment A $3,500 minimum donation is required to join Team Eye and Ear and receive an invitational entry for the 2010 Boston Marathon. A $100 non-refundable deposit is required to be submitted along with your application. The fee must be paid by credit card. This fee will be counted toward your fundraising minimum and reserves a BAA invitational number in your name. Valid credit card information must be included with your application to apply for Team Eye and Ear. In the event you do not meet the minimum fundraising requirement by May 19, 2010, Massachusetts Eye and Ear Infirmary will charge the balance owed to your credit card. Cancellation Policy You may cancel your participation with Team Eye and Ear for the Boston Marathon, waiving your responsibility for the $3,500 minimum, any time on or before January 1, 2010. You must contact Kristina Sym at the Massachusetts Eye and Ear Infirmary in writing, on or before the cancellation date. Your $100 deposit is non-refundable. After January 1, 2010, you are responsible for raising or personally giving the entire $3,500 minimum, even if for any reason, including injury, you are unable to run in the marathon. Donations raised and received by our office will not be refunded, even if you cancel before January 1, 2010. Registration The Massachusetts Eye and Ear Infirmary will inform you of the details of BAA registration. The BAA charges a $250 race application fee that each runner is responsible for and that does not count toward your fundraising minimum. This fee will be collected separately at a later date. You should NOT contact the BAA directly to secure your number. Liability Mass. Eye and Ear is not responsible for injury or death related to training for, or participating in, the Boston Marathon as part of Team Eye and Ear. Signature of Team Member Printed Name Date submit for consideration Please submit completed Application, Fundraising Agreement, and Terms and Conditions Agreement to: mail Kristina Sym c/o Development Office Massachusetts Eye and Ear Infirmary 243 Charles Street Boston, MA 02114 fax (617) 573-3444 e-mail kristina_sym@meei.harvard.edu
2010 application personal information: Are you BAA Qualified? No Yes If yes, qualifying time & marathon: Last Name: First Name: Mr. Ms. Mrs. M.D. Ph.D. Other (please specify): Gender: Male Female Age: Birth Date: Home Address: City: State: Zip: Home/Cell Phone: Email Address: Employer: Title: Work Address: City: State: Zip: Work Phone: Send mail to: my home address my work address Fundraising: Have you ever participated in a marathon or other charity fundraising program before? Yes No If so, which charity and how much money did you raise? What is your fundraising goal for this year s marathon program? While the required minimum is set at $3,500 per runner, we are asking that the runners set a personal goal of at least $5,000 to help achieve a team goal of $275,000. Aim high and you will be amazed at what you can achieve! For what purpose would you like your donation designated? Wherever the need is most (unrestricted) My physician / area: Does your employer participate in a matching gift program to hospitals? Yes No Marathon History and Running Experience Have you run a marathon before? No Yes: If yes, how many? When was your most recent marathon? How many miles do you run per week?
Additional information Mass. Eye and Ear will provide Team Eye and Ear marathon team members with a team singlet. Please circle appropriate size below: Men s Women s S M L XL How did you hear about the Team Eye and Ear Marathon Program? Have you had first hand experience at Mass. Eye and Ear? Please describe why you would like to run for Mass. Eye and Ear. questions Please contact Kristina Sym at (617) 573-6364 or kristina_sym@meei.harvard.edu submit for consideration Please submit completed Application, Fundraising Agreement, and Terms and Conditions Agreement to: mail Kristina Sym c/o Development Office Massachusetts Eye and Ear Infirmary 243 Charles Street Boston, MA 02114 fax (617) 573-3444 e-mail kristina_sym@meei.harvard.edu
2010 FUNDRAISING AGREEMENT (required to submit with application) Please read and sign the agreement below and provide your credit card number. I understand that my initial $100 deposit and all additional funds raised will support the Massachusetts Eye and Ear Infirmary and that an additional Boston Marathon Application fee of $250 will also be required, payable to the Boston Athletic Association (to be paid at a later date). The BAA application fee does not count toward the total fundraising amount. Please charge my $100 non-refundable deposit to the credit card listed below. I agree to collect a minimum of $3,500 by May 19, 2010 to support Massachusetts Eye and Ear Infirmary. This minimum amount is inclusive of the $100 non-refundable deposit. I understand that the Massachusetts Eye and Ear Infirmary reserves the right to charge the credit card listed below for the balance I owe if I have not submitted the entire $3,500 on or before May 19, 2010 or if I withdraw from the program after January 1, 2010. Name (as it appears on the card) Signature Credit Card number Expiration date Visa Master Card American Express submit for consideration Please submit completed Application, Fundraising Agreement, and Terms and Conditions Agreement to: mail Kristina Sym c/o Development Office Massachusetts Eye and Ear Infirmary 243 Charles Street Boston, MA 02114 fax (617) 573-3444 e-mail kristina_sym@meei.harvard.edu