Empire One Running Club Membership Application
    
 *www.empireonerunningclub.org*
   



 Name_________________________________________________Sex_____BirthDate__________

 Address__________________________________________________________________________

 City/Town_________________________________________________State_____Zip___________

 Phone Number_____________________________ e-mail:_________________________________

 Do you want to be included on The Res-Dogs e-mail list? Yes_____No____
 (The Res-Dog e-mail list is a EORC communication tool.)

 Membership Fees: ____Adult $20.00 ____17& under $15.00 ____Family $30.00

 Name__________________________________Relationship________

 Name__________________________________Relationship________

 Name__________________________________Relationship________

  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 decisions of a race official relative to my ability to safely complete the run. I assume all risks associated with running and volunteering in club races including, but not limited to: falls, contact with other participants, the effects of weather, including high heat and/or humidity, the conditions of 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 the membership, I, for myself and anyone entitled to
 act on my behalf, waive and release Road Runners Club Of America, The Empire One Running Club Inc. and all sponsors, their representatives and successors from all claims or liabilities of and arising out of my participation in these club activities even though that liability may be of negligence or carelessness on the part of the persons named in this waiver.

   *"ALL MEMBERS ARE REQUIRED TO WORK AT LEAST ONE EORC EVENT PER CALENDAR YEAR."*

 SIGNATURE:_________________________________DATE_________

 [Parents if under18]_____________________________DATE_________

 MAIL FORM AND FEE TO: EMPIRE ONE RUNNING CLUB, P.O. BOX 733, HOLYOKE, MA 01041-0733