Membership Application

MEMBERSHIP DUES: Are $20.00 yearly starting January 004 through 05. If you would like to pay ahead for additional years, add $20.00 per year. Additional family members in the same household are $1.00 each year or portion of a year. New primary members joining for the first time get a free KRC logo T-shirt.

Name Date of birth

First________________MI____Last___________________M/D/Y______ Sex_____

Address________________________City____________________State____Zip____________

Home Work

TEL_________________Tel_________________________Tel____________________________

Running

Interest______________________________________________________Occ__________________Dues_________

Other family members joining

(list name, date of birth, sex)_____________________________________________________________________

E-mail address if applicable____________________________________________________

Total dues_______________

WAIVER, RELEASE AND INDEMNITY AGREEMENT

KRC has obtained an insurance policy through RRCA, which provides coverage for events other than races. Through this insurance we are covered for weekly runs, hash runs, picnics and social events. Volunteers at races and other Club functions are covered. We need you to sign the wavier below for additional coverage. This will be kept on file.

WAIVER: I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter a 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 abilities 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 effect of weather, including high heat and / humidity, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this wavier and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and anyone one entitled to act on my behalf, waive and release the Road Runners Club Of America, The Kernersville Running Club, and all sponsors, their representatives and successors from all clams or liabilities 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 wavier.

Primary Member

Signature__________________________________Date_____________

Signature of other

Individuals to be covered

(parent or guardian if under18)__________________________________

Mail Membership Application and Waiver to –KRC Membership, cc. Blake Ward, 380 Fielding Drive Kernersville N.C. 27284. Make Checks to The Kernersville Running Club.