Website Membership Form

Please print this page and mail one page per membership to the address below.  Thank you and thanks for joining!

Last Name__________________________First Name___________________

Address________________________________________________________

City________________________________State_______Zip______________

Date of Birth_____________Sex_________Occupation___________________

Home#___________________email_________________________________

How did you hear about us?________________________________________

Preffered group run pace group_________Boston Qualifier?_______________

Please do not publish in directory:  ___phone ___address___email

Membership type:____new member     _____renewal 

Individual: ____1 year = $20       ____Student*= $15     _____Family**= $30

*student is defined as a full time high school/college student

**Family is defined as two adults within the same household and dependent children under the age of 21

Waiver: I understand that running and volunteering to work in club activities is a potentially hazardous activity.  I should not enter and run in a race unless I am medically able and properly trained.  I assume all risks associated with running and volunteering to work in a race including, but not limited to, falls on the course, contact with participants, effects of weather, conditions of the course, all 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 memebrship, I, for myself, and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, Medina County Road Runners, its officers, their representitives and successors, and all sponsors from all claims and liabilities of any kind arising out of my participation in these club activities.  I hereby grant permission to the Medina County Road Runners the use of photographs of myself and/or my minor family members in the Medina County Road Runners newsletter and/or publications to include their website.

SIGNATURE:__________________________________________DATE_____________

(parent/guardian if under 18)

Please send form and check payable to MCRR to: Medina County Road Runners, c/o 8579 Markley Drive, Wadsworth, Ohio 44281. ATTN: Joe Herbert