OVRWC MEMBERSHIP APPLICATION

LAST NAME _____________________________FIRST ______________________MI _______       SEX: _______      DATE: OF BIRTH____/_____/_____

ADDRESS _____________________________________________________________________________     HOME PHONE _________________________ 

CITY ________________________________________     STATE ____________    ZIP ____________                  WORK PHONE _________________________

E-MAIL ADDRESS (Optional) :____________________________                       # YEARS RUNNING?:____________ OR WALKING?: ____________

WILL YOU HELP WITH CLUB EVENTS __________?        SINGLE ($12)_________   FAMILY (SAME ADDRESS $17)______STUDENT OR SENIOR $8_______                 

 ALL MEMBERS MUST READ AND SIGN THIS WAIVER

I know that running, walking 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, walking, 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 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 Ohio Valley Runners/Walkers 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 person named in this waiver.

______________________________________________________________                     ________________________________

Signature                                                                                                                                        Date

______________________________________________________________                     ________________________________

Parent's Signature for members under 18 years                                                                               Date

RETURN TO: OVRWC, PO BOX 6707, WHEELING, WV 26003

 Note: If Family Membership, please have each member complete a separate application