ORANGE RUNNERS CLUB MEMBERSHIP APPLlCATION Name:
Date of birth:
Age:
Sex: (circle one) male female
Mailing Address:
City:
State:
Zip:
Phone Number:
Occupation:
Membership type: (circle one) Regular/Family-$15 - Students (18 and under)/Seniors (60 plus)-$10
Are you: (circle one) - Renewing - A New Member - Indicating Address Change Club Membership Waiver
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 safety 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 effect of the weather, including high heat and/or humidity, the conditions of the road and traffic on the course. All such risks having been 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 Orange Runners Club Inc., the Road Runners Club of America and all sponsors, their representatives and successors from all claim 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. Signature :
Date:
Parents Signature (if under 18) :
Date:
Please send the completed application along with a check for the proper amount payable to: The Orange Runners Club/ P.O. Box 2144 / Middletown, NY 10940 This special membership will be effective through December 31, 2001. At that time you may renew your membership. |
