Run the 2019 United Airlines NYC Half in support of NAMI-NYC!
We appreciate your support through fundraising to expand our programs and services to more individuals and families impacted by mental illness in New York City. As a member of NAMI-NYC Runs Team, the benefits you will receive include:

- Kick-off event to get to know your NAMI-NYC Runs Team-mates and learn more about the work NAMI-NYC does
- NAMI-NYC Runs Team training program
- Customizable online fundraising page
- NAMI-NYC Runs Team race-day tech shirt
- Weekly emails from NAMI-NYC Runs, including program information & fundraising ideas
- NAMI-NYC Runs Team Facebook page to stay connected to your teammates and to NAMI-NYC

**By submitting this application to run the 2019 United Airlines NYC Half for NAMI-NYC Runs as a Guaranteed Entry Charity Runner, you are committing to fulfill the fundraising requirement you select:

Option A - $1,500
Option B - $1,750

*If you already have your own entry into the 2019 NYC Half Marathon, and would like to raise funds for NAMI-NYC, and are not seeking Guaranteed Entry into the race, please select Option C below.

I. Participant Status
Please choose one *
II. Elections and Agreements
I elect to participate in the 2019 United Airlines NYC Half as part of team NAMI-NYC Runs and to raise at least the fundraising minimum of $1,500 (Option A) or $1,750 (Option B) by March 16, 2019. I recognize that my participation is contingent upon this commitment schedule and understand that if due dates are not met, I will be personally responsible for the fundraising minimum.

Cancellation Policy: You are responsible for raising the $1,500 (Option A) or $1,750 (Option B) minimum by the deadline. All registrations are non-refundable and non-transferable.

If an athlete is injured during training after February 14, 2019, he or she is still responsible for raising or providing the $1,500 (Option A) or $1750 (Option B) minimum, regardless of whether or not they are able to compete. Additionally, if any portion of race and/or the entire event is canceled for any reason beyond the control of NAMI-NYC, the athlete is still required to raise $1,500 (Option A) or $1750 (Option B) by March 16, 2019.

Failure to complete the minimum fundraising requirement by the dates listed will result in the runner being removed from the race and they will not be able to participate in the 2019 United Airlines NYC Half if NAMI-NYC is unable to charge their credit card.

I accept *
Required
III. Your Information
Title *
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Date of Birth *
MM
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YYYY
Current Age *
Your answer
Gender *
Ethnicity/Race *
Household Income *
Employer *
Your answer
Job Title *
Your answer
Does your company have a matching gift program? *
Phone *
Your answer
Email (a confirmation will be sent to your email address) *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact Relationship to You *
Your answer
Have you previously participated in any fundraising events for NAMI-NYC, such as NAMIWalks? *
Are you a member of NAMI-NYC’s Young Professionals Advisory Board? *
How did you find out about NAMI-NYC Runs? *
If Friend or Other selected, please specify
Your answer
Are you planning to participate in the NAMI-NYC Runs training program?* *
IV. NAMI-NYC Engagement
Are you interested in:
Are you or someone in your family currently using services provided by NAMI-NYC? *
Have you or someone in your family used NAMI-NYC’s services in the past? *
If yes, which ones?
If Other, please specify
Your answer
Are you interested in learning more about our programs and services? *
If yes, for a person living with a mental illness or for friends and family members of a person living with a mental illness?
V. Interest in our Cause / Runner History
Why do you want to run with team NAMI-NYC Runs? Do you have a specific connection to the cause? If so, please explain. *
Your answer
What is your personal fundraising goal? *
Your answer
What is your fundraising experience? How do you plan to achieve the fundraising minimum $1,500 (Option A) or $1750 (Option B)? *
Your answer
Have you ever run for another charity team or raised money for another cause? If so, please elaborate. How much were you able to raise? What techniques did you find helpful in achieving this level of fundraising? *
Your answer
What is the longest distance you’ve ever run? (Check all boxes that apply)
How many previous half marathons have you run? *
Your answer
Personal Best half marathon time (HR:MIN)
Your answer
VI. Size Information
NAMI-NYC Runs will be providing its runners with one tech shirt. Please indicate your preferred size:
Tech Training Shirt *
VII. Agreement & Release of Liability
I acknowledge that I have volunteered to participate in the NAMI-NYC Runs 2019 United Airlines NYC Half fundraising initiative, organized by the National Alliance on Mental Illness of New York City, Inc. (“NAMI-NYC”), and have committed to raise a minimum of $1,500 (Option A) or $1750 (Option B) by March 16, 2019.

In consideration for being permitted by NAMI-NYC to participate in this initiative, I agree that I and my heirs, guardians, legal representatives, successors, and assigns, will not make a claim against, sue, attach the property of, or prosecute any of NAMI-NYC, its affiliated organizations, and their officers, directors, agents and employees, for any losses, personal injury, death or property damage which I may have, or which may hereafter accrue to me as a result of my participation, directly or indirectly, in the fundraising initiative and/or in any and all of the activities involved in the NAMI-NYC Runs program, whether caused by the negligence of NAMI-NYC or otherwise.

In addition, I agree to release and hold harmless NAMI-NYC and its affiliated organizations, their officers, directors, agents and employees, from all actions, claims or demands, including claims based on the negligence of NAMI-NYC and its affiliated organizations, that I, my heirs, guardians, legal representatives, successors and assigns may have for any loss, personal injury, death, or property damage, directly or indirectly, resulting from my participation in the fundraising initiative and/or the activities of NAMI-NYC Runs.

In executing this Agreement and Release, I specifically confirm the following:

1. I understand that training for and participation in a half marathon is a rigorous and potentially hazardous activity. I further understand that any training information or tips provided to me by NAMI-NYC and its affiliated organizations is for general use, and may not be appropriate for my use or my medical or physical condition, and that following any training program, does not ensure completion of a half marathon without injury. I agree that NAMI-NYC and its affiliated organizations, their officers, directors, agents and employees, shall not be liable or responsible for any injury arising out of or in connection with the training programs, information or tips.

2. I understand that NAMI-NYC and its affiliated organizations do not own, operate, or sponsor the race or operate or control the race course, and I accept and fully assume all risks associated with participating in the event, including, but not limited to falls, contact with vehicles, other participants, spectators or others, the effect of the weather, including high heat, extreme cold, icing, rainfall, flooding and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. I further agree that NAMI-NYC and its affiliated organizations, their officers, directors, agents and employees, shall not be liable or responsible for any acts or omissions of the event sponsors.

3. I understand that all travel services, including transportation, lodging and meals (to the extent that they are included in the program) are provided by independent contractors who are not agents or employees of NAMI-NYC or its affiliated organizations. I agree that NAMI-NYC and its affiliated organizations, and their officers, directors, agents and employees, shall not be liable or responsible for any losses, personal injury, death, or property damage arising out of or in connection with these travel services or for the acts or omissions of such independent contractors or volunteers.

I acknowledge and represent that I have carefully read this Agreement and Release and fully understand its contents. I am aware that this is a release of liability between myself and NAMI-NYC and its affiliated organizations, and I enter into this Agreement of my own free will. The initials or mark and the date that I provide on the application for NAMI-NYC Runs and submit for consideration serves as my signature and date for this Agreement and Release of Liability.

I understand that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of New York and that if any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I accept the terms of the Agreement and Release of Liability *
Required
VIII. Publicity Consent Form
I understand the following as it relates to publicity for NAMI-NYC and NAMI-NYC Runs activities and my personal activities related to NAMI-NYC Runs:

- That while this Publicity Consent Form is limited to the purpose(s) and by the restriction(s) detailed therein, my consent cannot later be revoked.

- That in the case of the news media, I do not have the option to review the final news story before it is published or broadcast, and NAMI-NYC does not have final control over the use or distribution of this material, and media outlets like television, radio and Web sites may reuse and re-disclose this information without obtaining permission from NAMI-NYC or my permission.

- That in the case of the Web, information can be captured by other entities and displayed on their Web sites, despite NAMI-NYC's copyright registration.

- That my name (and/or my child's name if relevant) may be used in connection with these materials, unless I have specifically restricted its use.

I release NAMI-NYC and its officers, directors, agents, and employees from any and all liability connected with the use or disclosure of these materials. I also waive all rights, interest or claim for payment in connection with any exhibition, use or disclosure of these materials.

This consent is voluntary, and I give it in the interest of public information and education, and for the furtherance of the goals of NAMI-NYC and for other lawful purposes. The initials or mark and date that I provide on the application for NAMI-NYC serves as my signature and date for this Publicity Consent Form.
I accept the terms of the Publicity Consent Form *
Required
IX. Credit Card Information
All NAMI-NYC Runs participant are expected to raise at least $875 by February 9, 2019 and the full fundraising minimum of $1,500 (Option A) or $1750 (Option B) by March 16, 2019. If the fundraising minimums have not been met by these two fundraising deadlines (February 9, 2019 for the halfway commitment and March 16, 2019 for the full commitment) applicants will be charged the remaining balance on the credit card provided below.

Please note that if you are accepted onto the NAMI-NYC Runs team (which will be confirmed by email), this credit card will be automatically charged $50 to secure your guaranteed spot. This WILL count towards your fundraising minimum.

Cardholder Name *
Your answer
Credit Card Number *
Your answer
Credit Card CCV (security code) *
Your answer
Expiration Date *
MM
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Please send a photo of yourself to events@naminyc.org.
Please contact us at events@naminyc.org with any questions about this process.

All applications will be reviewed on a rolling basis. All decisions will be announced by January 10, 2019.

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