2019 IRONMAN®
World Championship
Team Application

Team In Training has highly coveted entries for the IRONMAN® World Championship in Kailua-Kona, Hawai'i on Saturday, October 12, 2019 . This race is normally by-qualification-only, but Team In Training has limited guaranteed entries for those ready to impact the mission of The Leukemia & Lymphoma Society in a big way!

Please complete the below application for review by the Team In Training IRONMAN® World Championship Selection Committee. After submission of your application, a committee member will be in touch with you to schedule phone interviews.



About You

Gender *
calendar

Do you have a biography (personal or professional) already written about you? If so, upload a file and/or provide a link to anything online.

Link(s) to online bio info
Use the + sign to provide more than one


Social Media Accounts / Websites

Please provide URLs or handles for your social media accounts or any other sites where you may mention your Kona campaign. If you do not have one of these accounts, simply put N/A.
Other (if applicable)
Use the + sign to provide more than one


Photo(s)

The Leukemia & Lymphoma Society will only use photos of applicants that are selected. Examples of use: press releases, social media announcements of the selected team, internal announcements of the selected team, pitching news stories to media outlets, etc.





The Leukemia & Lymphoma Society

Have you previously been involved with The Leukemia & Lymphoma Society in any capacity? *
Select all that apply. *
 
Have you been in communication with a staff member of The Leukemia & Lymphoma Society regarding your interest in the IRONMAN® World Championship and this application process? If yes, please share the staff contact(s) you've been working with. *
 
Do you have a personal connection to leukemia, lymphoma, Hodgkin's disease, myeloma, or other type of cancer and will be fundraising in honor or memory of someone specific? *
 NameAgeDiagnosisRelation to YouHonor/Memory
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Fundraising Commitment & Goal

The Leukemia & Lyphoma Society (LLS) receives limited bibs for this highly prestigious and sought after race. In order to maximize these opportunities towards the LLS mission, we must choose applicants who have the highest fundraising capacity. The Team In Training IRONMAN® World Championship Selection Committee is seeking individuals that can raise no less than $50,000 for The Leukemia & Lymphoma Society through their participation in the IRONMAN® World Championship. Over the last 6 years, our 26 athletes that have been awarded this opportunity have raised an average of $91,695 each.
Have you done any prior fundraising outside of Team In Training? If yes, with which organization and how much did you raise? *
 



Athletic / Training / Triathlon History

Have you previously completed an IRONMAN® 70.3®? *
Have you previously completed an IRONMAN®? *
Have you ever competed in the IRONMAN® World Championship before? *


Application

Have you previously applied for an entry to the IRONMAN® World Championship through Team In Training? *


Applicant Agreement

Please mark the check boxes next to each item below acknowledging you have read and understand the expectations of each selected athlete and LLS, then sign below.
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Signature of Applicant *
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Team In Training Waiver & Release Agreement

WAIVER & RELEASE AGREEMENT

Assumption of Risk and Complete Release of Liability

I, intending to be legally bound, understand and agree that I am voluntarily participating in a race, relay, endurance event, training program, sailing, boating, or other on-water activity, or other event(s) and all related activities (the “Event”) with The Leukemia & Lymphoma Society (“LLS”) at my own risk.

Assumption of Risk: I acknowledge that I am aware of the risks, both known and unknown, inherent in participating in the Event, including but not limited to: trips or falls; contact or collisions with other participants, spectators, or others; uneven surfaces; the effects of and exposure to weather and environmental conditions; and other training or Event course conditions; and that I HEREBY ASSUME SUCH RISKS and accept full responsibility for these activities, and for any injury, damage, death, or other loss suffered by me resulting from the Event and/or resulting from my own negligence or misconduct. I certify that I am physically fit, have not been otherwise informed by any physician, and know of no restrictions imposed on me that would prevent me in any way from actively participating in the Event.

Release and Indemnity Agreement: In consideration of being permitted to participate in this Event, I, on behalf of myself, my successors in interest, heirs, assigns, and representatives, hereby waive all rights of subrogation and fully release, waive, discharge, indemnify, and hold harmless LLS and its subsidiary and affiliated organizations, its officers, directors, agents, employees and representatives, successors and assigns (be they individuals or organizations, singly and collectively), together with their insurers (“Releasees”), from any and all claims, liabilities, demands, suits or causes of action, which are in any way connected with my participation in the Event, including for any injury, damage, death, or other loss. THIS RELEASE OF LIABILITY IS EFFECTIVE AND VALID REGARDLESS OF WHETHER THE INJURY, DEATH, DAMAGE, OR OTHER LOSS IS A RESULT OF ANY NEGLIGENT ACT OR OMISSION ON THE PART OF RELEASEES.

Medical Authorization: I hereby grant permission to the Releasees to render preventative or first-aid assistance or seek medical care that they deem reasonably necessary for my health and well-being, including transportation to a hospital or other medical facility. I agree to assume all risks and pay all costs associated with that assistance, care, and transportation.

Code of Conduct: I agree to comply with all rules, regulations, and safety procedures during my participation in the Event and realize that my failure to do so may result in further injury and damage to myself or others for which I will be liable.    

Publicity Release: In connection with my participation in the Event, I give permission for Releasees to use my name, photograph, likeness, and voice in any manner and in all media now or hereafter known, in perpetuity throughout the world, without compensation of any kind.

This Waiver & Release Agreement will be governed by and subject to the laws of the State of New York without regard to any conflict of law rules. Jurisdiction and venue in any matter arising out of this Waiver & Release Agreement shall be proper in the federal and state courts located in Westchester County, New York.

I have read and fully understand this Waiver & Release AGREEMENT and understand that I am assuming all the risks inherent in the Event and that I am releasing any and all claims that i may have as a result of my participation in the event.

Electronic Signature Consent: I further agree that my electronic signature or acknowledgment constitutes my acceptance of this Waiver & Release Agreement and will have the same legal effect as an original signature.

Signature of Applicant *
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