Annapolis Striders

Membership Application

 

Complete the following application and mail with payment to:

Membership, 8179 Forest Glen Dr., Pasadena, MD   21122

Checks made payable to Annapolis Striders, Inc.

 

 

 

Please circle:

        New     Renewal

 

 

 

 

 

 

Type of Membership:

Individual

1 yr-

$15

2 yr-

$28

5 yr-

$70

 

Two Person (same address)

1 yr-

$25

2 yr-

$46

5 yr-

$115

 

Family (3 or more)

1 yr-

$30

2 yr-

$55

5 yr-

$140

Junior membership: (under 18) requires parent signature- $6

 

 

Contact Information- Please print clearly

 

Name:  ____________________________________________________________

 

Address:____________________________________________________________

 

City:_____________________________  State:________________  Zip:_________

 

Phone:___________________________ Email:____________________________

 

Birth date: ____/____/____       Gender:  Male____ Female____

 

 

Additional Members: (same address- Two Person or Family memberships)

 

Name ________________________________ Birth date___________ Gender________

 

Name ________________________________ Birth date___________ Gender________

 

Name ________________________________ Birth date___________ Gender________

 

Name ________________________________ Birth date___________ Gender________

 

 

WAIVER AND RELEASE: I recognize that participation in activities of the organization may involve certain hazards. I understand that I should not participate unless medically able. I assume the risks associated with involvement in these activities, including but not limited to, falls, contact with participants, effects of weather, road and traffic conditions - these risks being known and appreciated by me. Having read the Waiver and Release and considering the acceptance of my application, I, for myself and anyone entitle to act on my behalf, waive and release the Annapolis Striders, Inc., the Road Runners Club of America, and all sponsors and hosts, their representatives and successors, from any claim or liability arising from my involvement in activities of the organization.

Signature of Applicant (Parent Signature if Under 18)     ____________________________________________________

Date ______________________

For additional information email astriders@hotmail.com

 

Please allow 4 weeks to process application.