2010 NEW MEMBER
& MEMBER RENEWAL FORM
Check One: _____
New Member
_____ Existing Member Renewal
Name:
___________________________________________________________________
Street Address:
__________________________________________________________
City, State, Zip:
__________________________________________________________
E-Mail Address:
__________________________________________________________
Home Phone: (______)_______________ Work Phone: (______)__________________
Date of Birth (mm/dd/yyyy): ___________ Gender: Male ________ Female ________
Is it OK to publish the
above information in the RRRC Membership Roster, for distribution ONLY to
current RRRC members (circle one)? YES NO
Membership: $10 Individual. Make check payable for Randolph Road Runners Club. If you have any questions regarding membership, please contact David Malin at (336) 629-3131, or email (preferred) at membership@randolphroadrunners.org or visit our website at www.randolphroadrunners.org
Club Commitment: We ask each member to consider
volunteering at club events.
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Mail application, signed membership waiver
statement and check to:
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MEMBERSHIP WAIVER
STATEMENT (All
Members Must Sign)
I know that
running and volunteering to work in club races are potentially hazardous
activities. I should not enter and run in club activities unless I am medically
able and properly trained. I agree to abide by any decision of a race official
relative to my ability to safely complete the run. I assume all risks
associated with running and volunteering to work in club races including, but
not limited to, falls, contact with other participants, the effects of the
weather, including high heat and/or humidity, the conditions of the road and
traffic on the course, all such risks being known and appreciated by me. Having
read this waiver, and knowing these facts, and in consideration of your
acceptance of my application for membership, I, for myself, and anyone entitled
to act on my behalf, waive and release the Randolph Road Runners Club and all
sponsors, their representatives, and successors from all claims of liability of
any kind arising out of my participation in these club activities even though
that liability may arise out of negligence or carelessness on the part of the
persons named in the waiver. Parent or Guardian's signature required if under
18 years old.
Signature: _______________ Date
__________