P O Box 7396
Wilmington, NC 28406

Name ____________________________________Sex ___DOB_________

Mate (if applicable) ________________________ Sex ___DOB ________ 

Address: ___________________________________________________

City: ________________________ State: ___ Zip: ________

E-mail Address: ____________________________

Phone (H) _____________________ Phone (W) _____________________

Memberships -- new or renewal -- run for one year from application date. 

Please check the  appropriate membership below:

Individual:                            Year $25.00 ____  

Family: (Includes children)     Year $30.00 ___

Junior: (18 & under)             Year $10.00 ___

 List Names, Sex, and Birthdate of Children on Reverse Side.

Waiver: I know that running and working as a volunteer in club races are potentially hazardous activities.  I should not enter in club activities unless I am medically able and properly trained.  I agree to abide by any decision by 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, effects of weather, including high heat and/or humidity, the conditions of the road  and traffic on the courses, 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 Wilmington Road Runners Club 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 liability may arise out of negligence or carelessness on the part of the persons named in this waiver.   

Signature (parent if minor) __________________________Date_______

Send to: Wilmington Road Runners, P O Box 7396, Wilmington, NC   28406