Membership Application

Two Rivers Running Club 2015 Membership Application

 

Name:_________________________________________________________________________________________ DOB:____________________________Sex: M/F

Address:________________________________________________________________________________________________________________________________

City/State/Zip_____________________________________________________________________________________________________________________________

Email:_________________________________________________HomePhone:______________________________CellPhone:_________________________________

Type of Membership:     _____ Individual ($15)      or   _____ Family ($25)

                                     (annual membership - valid until December 31, 2015)

 

Additional Family Members:

Spouse:____________________________________________________________DOB:______________________________Sex: M/F

Child#1:____________________________________________________________DOB:___________________­­­­­___________Sex: M/F

Child#2:____________________________________________________________DOB:______________________________Sex: M/F

Child#3:____________________________________________________________DOB:______________________________Sex: M/F

Make Checks Payable to:  Two Rivers Running Club

   911 William Drive

   Goshen, Indiana 46526

Waiver:  I agree for myself, and any other person named on this application, that: 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, conditions of the road or 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 Road Runners Club of America, Two Rivers Running Club, and all sponsors, their representatives and successors, from all claims or liabilities 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 this waiver. I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record for any legitimate purpose. I understand and will abide by the guidelines that bicycles, skateboards, roller skates or blades, and animals are not allowed in club races.

 Primary Member Signature:_________________________________________________________________________Date:_____________________­­_____

 Parent Signature:________________________________________________________________________________Date:__________________________

(if under 18 years of age)                                                                              
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