Join the newest running and walking club in West Virginia

Serving North Central West Virginia and the whole State!

Mountaineer Striders
Running and Walking Club

Membership Application
New Members will be provided meeting information

New Member’s Application Fees

Single $14.00_________Family $20.00__________Full time students & Seniors 65 & over $8.00________

Payable to Mountaineer Striders Running Club

TELL US ABOUT YOU! Miles per week you run?_____ Walk?_______ Years you've been running?_____
Walking?____ Your training pace?_____ How can the running/walking club help you? ________________

DATE__________________________________

NAME_______________________________________________SEX_____BIRTHDATE_________

ADDRESS______________________________________CITY_____________________________

STATE______ZIP__________HOME PHONE________________WORK PHONE______________

OCCUPATION______________________________WHERE_______________________________

E-MAIL ADDRESS_______________________________________________________

ADDITIONAL FAMILY MEMBERS JOINING:

NAME__________________________________BIRTHDATE________OCCUPATION__________
NAME__________________________________BIRTHDATE________OCCUPATION__________
NAME__________________________________BIRTHDATE________OCCUPATION__________
NAME__________________________________BIRTHDATE________OCCUPATION__________
ALL MEMBERS MUST READ AND SIGN THIS WAIVER
I know that running and volunteering to work in club races and related activities 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 of a club official relative to my ability to safely complete the event. I
assume all risks associated with running, any club-related activities, and volunteering to work in club events, including, but not limited to, falls, contact
with other participants, the effects of the weather, including high heat and/or humidity, the condition 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 RRCA, the Mountaineer Striders 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 even though
that liability may arise out of negligence or carelessness on the part of the persons named in the waiver.

Signature___________________________________________Date__________________
Signature___________________________________________Date__________________
Signature___________________________________________Date__________________
Signature___________________________________________Date__________________
Parent's signature for members under 18 years_____________Date___________________
Information: 304-848-3080 or 304-623-3303 (Ask for Application Form ) Your call will be returned.
Mail to Mountaineer Striders, 321 W. Main Street, Room 221, Clarksburg, WV 26301