Randolph Road Runners Club

2011 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:

Randolph Road Runners Club, 300 Foust Street, Asheboro, NC 27203-5406

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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 __________