White Mountain Milers Yearly Membership Dues are $10 per person or $15 for family. Please print out form (click here for printable form), fill in information, read waiver, sign and send with check or m.o. to: White Mountain Milers PO Box 1999 Conway, NH 03818-1999
Name: ___________________________________________________________ Date of Birth: ____________________________ Address: ________________________________________________________ City: _____________________________________ State: __________________ Zip: ______________ Day phone: ____________________Eve phone: ________________________ Email address: _______________________________________ 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 OF MEMBERSHIP, I, FOR MYSELF, AND ANYONE ENTITLED TO ACT ON MY BEHALF, WAIVE AND RELEASE THE ROAD RUNNERS CLUB OF AMERICA, THE WHITE MOUNTAIN MILERS RUNNING CLUB, AND ALL THEIR SPONSORS, THEIR REPRESENTATIVES AND SUCCESSORS FROM ALL CLAIMS OF 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 THIS WAIVER. SIGNATURE: _______________________________________________________________________________ DATE: _______________________ PARENTS SIGNATURE (IF UNDER 18): ___________________________________________________________ DATE: _______________________ _____ INDIVIDUAL MEMBERSHIP ____ FAMILY MEMBERSHIP INCLUDES:___________________________________________________________ ____ YES! YOU MAY CALL ME TO SEE IF I AM ABLE TO VOLUNTEER THROUGHOUT THE YEAR!
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