Team Endometriosis Foundation of America

NYC Half Marathon 2013

Registration and Commitment Form

The Endometriosis Foundation of America (EFA) is honored participate in the 2013 NYC Half Marathon. We greatly appreciate your dedication to the EFA and our mission. The EFA is a registered 501(c)3 non-profit organization - 100% of all donations received directly support EFA programs. Thank you for choosing to run with Team EFA!

Registration Form

Applications will be reviewed and runners will be accepted on a first come first serve basis. Runners will be notified by email of acceptance once their application has been received and reviewed. As a member of our 2013 ING NYC Half Marathon race team you will receive.

·  A Team Shirt

·  Training Plan based on individual needs

·  Group escort to the start line

·  Post Race meeting location with snacks for runner and guest

Participant Information

Name ______

Company ______

Address______

City / State / Zip/Code______

Telephone # ______

Fax#______

Email Address______

Gender: Male Female

T-Shirt Size: S M L XL 2XL

Team Endometriosis Foundation of America Commitment Form

All runners on Team EFA are required to raise a minimum of $1,000 in support of the EFA’s mission. Additionally, each runner is responsible for a $250 participation fee required by the NYC Half Marathon. All participants for Team EFA will be required to provide credit card information as a guarantee against their minimum fundraising requirement. If the minimum goal of $1,000 is not met by March 16, 2013 the EFA will automatically charge the remaining balance to the credit card provided. If the participant cannot attend and run the NYC Half Marathon for any reason (injury, personal reasons, etc.), the minimum required donation of $1,000 is still due to the EFA by March 16, 2013. A change of runner is subject to approval from the EFA and requires a $75 fee.

SIGNATURE______DATE______

Please complete this application form and email to , or fax to (314) 677-6477. Applicants will be contacted via email to confirm their acceptance and participation in the event. For questions and/or additional information please contact Kelly Britt at (314) 302-9148 or

Payment Information

Amex _____ Visa _____ M/C _____

Name as it appears on the card: ______

Billing Address: ______

Credit Card # (if applicable): ______

Signature (required to authorize use of this card): ______

Donations:

Donations can be made online at www.crowdrise.com/endo.

Checks must be made payable to the Endometriosis Foundation of America with specification of and sent directly to Kelly Britt at:

Kelly Britt

1134 Corrington Ct.

Town & Country, MO 63017

Please be sure to include the ING NYC Half Marathon and the name of the participant in the memo line.