Motor City Striders
Club Application
Fill out completely- Please Print Name ________________________________________________________________________________ Address____________________________City_________________________State_____Zip_________ Phone (____)________________________Birthdate__________________________ Male_________Female__________ Occupation________________________ Membership Fee: $15 Make all checks payable to The Motor City Striders Please return application to: Dr. Edward H. Kozloff, 10144 Lincoln, Huntington Woods, MI 48070 All memberships expire December 31, 2012 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 Road Runners Club of America, the Motor City Striders 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. _______________________________________________________________ _______________________________________________________ Member’s Signature Date Parent’s Signature (if under 18 years) Date