West Orange Runners' Club Membership Application

 

Check ONE:

_____ New Member - $40 (one time fee which includes tech shirt)

____ Annual Renewal - $25

____ Families - $40 for first member; $30 for other household members

ONLY CASH ACCEPTED. Application and Dues can be dropped off at Tri & Run.

 

Name:___________________________

Address:___________________________

__________________________________

Phone:____________________________

Email:____________________________

Sex: ____________________________

Date of Birth:____________________

Shirt Size:_________________________

Reason(s) for wanting to get involved:_______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Any special service that you would like to offer to the group?_____________________________________________________________________

Where did you hear about us?______________________________________________________________________________________________

 

Upon submission of this application and accompanying signature, I agree to assume all risks associated with participation in any activity of the W. Orange Runners' Club. I release all sponsors, officers, employees and any and all persons assisting on a volunteer basis from any and all claims of liability resulting from my participation.

 

 

_____________________________________________________________________

Signature and Date