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Permian Basin Road Runners Club

Membership Application, Membership Renewal, or Change of Address Form

    Last Name     First Name

                Address email address

                City    State    Zip + 4

                Area Code    Work Phone    Home Phone

                Gender    Age     Date of Birth

                List additional family members (all members must sign a waiver)

                Last name, first name, Gender, birthday, age

           

           

           

           

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 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 Permian Basin Road Runners Club and all sponsors, their representatives and successors from all claims or liabilities of any kind ensuing out of my participation in these club activities even though that liability may arise out of negligence or carelessness on the part of the person named in this waiver.  I grant permission to all the foregoing to use any photographs, motion pictures, recordings, or any other record of this event for any legitimate purpose. I understand that bicycles, skateboards, baby joggers, roller skates or blades, animals, and radio or tape headsets are not allowed in the race and I will abide by this guideline.

Signature (Parent or Guardian must sign for minor children

________________________________________________Date______________________

 

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