London Marathon Place Ballot Form

If you wish to be entered into the Ballot for the Nexus NI London Marathon place please read the terms and conditions on page 3 andfill in and sign the form. The form needs to be returned to Tara O’Hara at Nexus NI, 119 University Street, Belfast BT7 1HP or email by 20th Feb2017. The ballot result will be announced by 27th Feb 2017.

Your details:

Full name
Date of birth
Email:
Telephone:
Twitter handle:
Postcode
Address Line 1
Address Line 2
City / Town:
County:
Country:
Postcode:
T-shirt size:

Your relationship to Nexus:

I would like to run the London Marathon for Nexus because:
Please tell us how you first heard about Nexus:

Your fundraising plan:

Please outline in the table below the activities you plan to undertake to raise the £500 for Nexus NI.

Activity / Description / Timeframe

Your running history:

Do you currently run regularly?

Have you ever run a marathon before?

Did you enter the London Marathon ballot for individual places?

What is your estimated marathon time?

Your occupation:

Occupation:

Employer:

Does your employer run a matched giving scheme? (If so, please give details)

Your agreement:

I plan to undertake the following Fundraising activities in order to raise a minimum of £500 for Nexus NI by 23rd June 2017.I have read the Terms and Conditions:

Signature:______

Date:______

Nexus’s 2017 Virgin Money London Marathon charity place terms and conditions

By completing an application for a Nexus place in the London Marathon, you agree to the following Terms and Conditions. Places are highly sought after, so please read the following carefully.
Nexus has one place in the London Marathon. To apply for the place to run the 2017 Virgin Money London Marathon for Nexus, you must pledge to pay in a declared sponsorship of £500 or more to Nexus (via Nexus’s stipulated payment methods) by Friday 23rd June 2017. Your application will be subject to a selection process, so that Nexus can ensure that our guaranteed charity place is used to the best-possible effect (as determined by Nexus). Therefore please ensure you submit a fully detailed fundraising plan on your application form. The deadline for Nexus receiving applications for the 2017 Virgin Money London Marathon is 20th February 2017.
If your application is successful, you agree to pay a £20 non-refundable entry fee to Nexus. Nexus will not refund this fee under any circumstances. If you cancel your Nexus place for any reason, your £20 entry fee will be used as a donation to the Nexus fund that all 2017 Virgin Money London Marathon fundraising is allocated to.
If you are allocated theNexus charity place then you must agree to only fundraise for Nexus. If you set up a Virgin Money Giving page or any other online giving page, 100% of your fundraising must be for Nexus.
If your application is successful, Nexus will notify you by email and will explain how to pay your £20 entry fee. You must pay your £20 entry fee within 14 days of this notification; otherwise you risk losing your guaranteed charity place to another applicant.
Any existing regular donations which you make to Nexus do not form part of the total raised through sponsorship.
Nexus will advise you on therecommended way(s) to pay in your sponsorship. This is to ensure that Nexus can easily trace funds that you pay in.
If you decide not to run the Virgin Money London Marathon – or decide to run for another charity – you must inform Nexus immediately.
IMPORTANT: If you sustain a training injury please contact Tara, Business Development Manager at Nexus. It is important that you do not take part in the Marathon unless you are completely fit to do so.
By submitting this Nexus guaranteed charity place application form to Nexus, you will be deemed to have read and accepted the above Terms and Conditions.
Application forms for Nexus London Marathon charity places should be completed with the form above or printed, completed and submitted to: Tara O’Hara, Nexus NI, 119 University Street, Belfast BT7 1HP or emailed to

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