Print this form on your web browser and return to: Dr. Edward H. Kozloff Motor City Striders 10144 Lincoln Huntington Woods, MI 48070

Fill Out Completely- Please Print

Name First: ___________________ Middle ____ Last___________________________

Address:_______________________________________________________________

City:_____________________________________State/Province_______ Zip ________

Area Code: _____ Telephone ____-__________ Date of Birth: _____________________

Sex: Male___ Female ___ Occupation: ________________________________________

Renewal?  ___ No   ___Yes  _________Membership Number

If renewing, include your membership number which can be found next to your name on your Strider Newsletter mailing label.

Make all checks payable to: The Motor City Striders  Membership Fee: $15.00   All memberships expire December 31, 2007

ON THE ROAD TO VICTORY!

Club Membership Application Waiver

I know that running and volunteering to work in club races are potentially hazardous activities. I should never 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 humity, 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 Road Running 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.