APPLICATION FOR TEAM DIGNITY MATTERS
    2024 FALMOUTH ROAD RACE

    To be considered for a spot on Team Dignity Matters and receive a bib to run the 2024 Falmouth Road Race, please complete and submit the form below.

    This application must be completed and returned by June 15, 2024.

    Team Dignity Matters requires a $1,500 minimum fundraising commitment from each runner at the 2024 Falmouth Road Race.

    If you have any questions, please email Meryl: meryl@dignity-matters.org.

    Thank you!

    Last Name:
    First Name:
    Address:
    City: State: Zip:
    Home Phone: Cell Phone:
    Age: Email address:
    Employer Name: Title/Occupation:
    Employer Street address:
    City: State:Zip:
    Work Phone:
    Work Email Address:
    I would like to be contacted at:

    Women’s Shirt/ Size (select one):

    Does your company have a matching gifts program?

    Matching Gift Policy: Many companies match employees’ charitable contributions. You can check with your employer and ask your donors if their employers match gifts. Many companies issue matching gift checks quarterly or semi-annually: if you plan to use a match to reach your minimum, it is your responsibility to contact the matching company to ensure the check is issued before the fundraising deadline; otherwise, it may not count towards your fundraising minimum. It is your responsibility to request any documentation your employer needs from Dignity Matters.

    Fundraising experience

    Have you participated in a road race charity program before?
    If yes, Charity Name:
    Amount raised: $ When did you participate:

    What will your fundraising goal be for DIGNITY MATTERS? (minimum $1,500):

    Please share your plans and ideas for raising these funds:

    Please describe any prior fundraising you have done for nonprofit/community organizations:

    Dignity Matters may choose to include a biography, photograph and other materials on its website and social media to promote your Falmouth Road Race fundraising efforts. Do you agree to include such information on the Dignity Matters website and social media?

    Running Experience

    Have you run a 5k, 10k, or 7-mile race before? If so, what were your finishing times?

    Are you confident that with proper training you can complete the 7-mile Falmouth Road Race?

    How did you learn about the Dignity Matters Falmouth Road Race Fundraising program? Please tell us why you would like to run to raise money for Dignity Matters!

    DIGNITY MATTERS TERMS AND CONDITIONS for the 2024 Falmouth Road Race
    Please read the following carefully before signing below:

    Fundraising Commitment: A minimum fundraising commitment of $1,500 (“minimum donation”) is required to join Team Dignity Matters and receive an entry for the 2024 Falmouth Road Race. Valid credit card information must be included with your application for Team Dignity Matters. You have until August 31, 2024 to meet the minimum donation. If you do not meet the minimum donation by 11:59pm EST on August 31, 2024, Dignity Matters reserves the right to charge the balance to your credit card. MasterCard, Discover, Visa, and American Express are accepted.

    All charity bibs will be honored to run the 2024 Falmouth Road Race in person on August 18, 2024, unless a runner selects the At-Home Edition when they register.

    CANCELLATION POLICY: You may cancel your participation at the Falmouth Road Race with Team Dignity Matters, waiving your responsibility for the minimum donation, on or before June 15, 2024. To do so, you must notify Dignity Matters in writing on or before June 15, 2024. After June 15, 2024, you are responsible for raising the minimum donation, even if for any reason, including injury, you are unable to physically participate in the Falmouth Road Race.

    Race Registration: Dignity Matters will provide registration instructions after your application is accepted. You should NOT contact the Falmouth Road Race directly to register.

    RELEASE FORM AND CONTRIBUTION AGREEMENT: In consideration of my accepting this entry, I hereby for myself, my heirs, executors and administrators, waive and release any and all rights for claims and damages I may have against Dignity Matters, its employees, volunteers, officers and sponsors for any and all injuries suffered or sustained by me in said event, in the training and planning sessions for said event, or travel to or from any of the preceding. I further attest and certify that I am physically fit and have sufficiently trained for competition in this event, and a licensed medical doctor has verified my physical condition. I also grant permission for use of my name and or photograph or voice in broadcast, telecast, print or any other account of this event and agree to waive any compensation for such use. I agree to collect the minimum donation for Dignity Matters by August 31, 2024, unless prior written arrangements have been made. If I have not reached the minimum donation by that date, I will personally be responsible for the balance owed. I understand that unless I cancel by June 15, 2024, Dignity Matters reserves the right to charge the balance I owe to my credit card. I declare that I have exercised my own judgment in signing this agreement and I further declare that the decision to sign this agreement was voluntary and not based on or influenced by any representation of Dignity Matters. In the event of an illness, injury or medical emergency arising during the event or in the training and planning sessions for said event, I hereby authorize and give my consent to Dignity Matters to secure from any accredited hospital, clinic and/or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment, and hospitalization.

    Please Type Name:
    Signature:

    Date:
    Credit Card Number
    Your card will not be charged unless you fail to raise the $1,500 minimum by August 31, 2024

    Credit Card Expiration Date