River City Rebels Running Club
Renewal and New Membership Application

Set browser margins as small as possible to print application, fill out, and mail
OR
Renew/Sign up Online at Active.com

____ New Membership Application

____ Renewal         ____ Name and Address Changes Indicated Below

Dues: (Check the one that applies)
  ____ Individual and family membership before July 1, 2010 ($25)
____  Individual and family membership after June 30, 2010, ($15)
$ _______  Amount Owed (You may pay dues for multiple years if you wish.)

Name:  ___________________________________________________________ 

Address: _________________________________________________________

City: ________________________________________ State: ___  Zip:  ______

Home Phone:  _______________ Work:  _______________   Cell:_______________

Gender: ___ Birthdate (m/d/y): ______________  PA/USATF #: ______________

E-mail Address: _____________________________________________________

(Please attach name, birth date, and gender for all family members who are joining.)

CLUB MEMBERSHIP APPLICATION WAIVER

I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and 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 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 high heat and/or humidity, the conditions 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 for membership, I, for myself and anyone entitled to act on my behalf, waive and release the River City Rebels Running Club, USATF, and all sponsors, their representatives and successors from all claims 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 in this waiver.

Signature: __________________________________  Date: _____________

Mail application & check to: River City Rebels, P.O. Box 189667, Sacramento, CA  95818