Alton Road Runner Membership Form

  • Address Change                         
  • New Member
  • Renewal
  • Phone Change
 For Offical Use Only
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Name_________________________________________________________
Address_______________________________________________________
City____________________________State_________________Zip_______
Home Phone_____________________Business Phone__________________
Occupation_____________________________________________________
Date of Application_____________________

Mail to: Linda Dietrich
             5007 Eiffel Court
             Godfrey, IL   62035

Membership fee is $8.00 for single, Family $15.00. Pay to: Alton Road Runners. Term of membership is April 1 thru March 31. Join in January and membership is good thru April of the next year. If both parents, or a single parent join, children are memebers.

Club Membership Application Waiver

I know that running and volunteering to work in club races are potentially hazardous activities. I shoul not enter and run in club activities unlesss I an medically able and properly trained. I agree to abide by any decision of a race offical 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 heat and/or humidity, the conditiond 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 of membership, I, for myself and anyone entitled to act on my behalf, waive and release the Road Runner Club and all sponsors, their representatives and successors from all clains or liabilities of any kind arising out on my particapation in these club activities even though the liability may arise out of negligence or carelessness on the part of the person named in this waiver. WAIVER MUST BE SIGNED.

Signature________________________________________________________ Date___________________

Parents Signature_________________________________________________ Date___________________
(if under 18 years)