Six Rivers Running Club Membership Form

                                                          Membership Rates
        Print this form, fill it out,                                   Beginning
        and mail it with a check to:              Individual    Family    Period 
                                                      $20         $25     Jan-Mar
          Six Rivers Running Club                     $18         $23     Apr-Jun
          P O Box 214                                 $15         $20     Jul-Sep
          Arcata, CA 95518                            $12         $15     Oct-Dec
                                                           (until the end of each year)
        Name _____________________________________________________________________

        Mailing Address __________________________________________________________

        City __________________________________  State _____  Zip Code____________

        Sex ___ Age ____ Birthdate _________________ Phone (_____) _______________

        E-Mail____________________________________________________________________
              (*Confirmation will be sent through e-mail only. PRINT clearly.)
        
        In case of EMERGENCY, contact:______________________ Phone:___________________
                                                (*REQUIRED. PRINT clearly.)
  
       *Would you like to donate to Relay for Life? ($5.00 suggested):__________

        For family membership, list members of family:

        Name ______________________________ Sex ___ Birthdate ____________________

        Name ______________________________ Sex ___ Birthdate ____________________

        Name ______________________________ Sex ___ Birthdate ____________________

        Name ______________________________ Sex ___ Birthdate ____________________
        Waiver: I know that running a road race is a potentially hazardous activity which 
        could cause injury or death. I should not enter and run unless I am medically 
        able and properly trained. I assume all risks associated with running in an 
        SRRC event, including but not limited to: falls, contact with other 
        participants, the effects of weather, traffic, and the conditions of the road. 
        I understand that bicycles, skateboards, baby joggers, roller skates or blades, 
        animals, and radio headsets are not allowed at SRRC races and I will follow 
        this guideline. Having read this waiver and knowing these facts, I, for myself 
        and anyone entitled to act on my behalf, waive and release the Six Rivers 
        Running Club and all sponsors and their representatives from all claims or 
        liabilities of any kind arising from my participation in an SRRC event even 
        though that liability may arise out of negligence or carelessness on the part 
        of the persons named in the waiver.

        ___________________________________________ _____________________________
        Signature                                   Date

        ___________________________________________ _____________________________ 
        Parent's signature if under 18              Date

        Would you like to volunteer? ___General Help ___Contact me if you need me.
        THANK YOU!