Make your own free website on Tripod.com

White Mountain Milers

Yearly Membership Dues are $10 per person or $15 for family. Please print out 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!