This is not an online form. It is intended to be printed and mailed.

North Coast Striders
Membership Application

For existing members only: To update NCS membership records, please check yes or no if your address, phone number, or E-mail address changed from last year.

DUES: Check one

Individual (Single)	Family
1-Year ($12.00) 3-Year ($33.00) 5-Year ($50.00)	1-Year ($18.00) 3-Year ($50.00) 5-Year ($75.00)

Note: The first day of the month in which you pay your dues is your anniversary date for membership. It will be indicated on your newsletter mailing-address label.

Membership Qualifications - None.

BENEFITS:

• Newsletter with club news, events and a local race schedule.
• Quarterly RRCA News Magazine "Footnotes"
• Insurance coverage of all RRCA sponsored events.
• Discounted race fees for all NCS sponsored runs.
• Camaraderie with other "Striders"
• The club hosts two or three social gatherings annually, including the annual Holiday Party !

Please check the function at which you would like to help:

 Newsletter
 Social Events
 Finish Lines
 Willits Classic (Feb.)
 Boontling Classic (May)
 Coyote Classic (Sept.)
 Turkey Trot (Nov.)
 Board Member

Family Members (family membership only)

Name: Birthdate:

Name: Birthdate:

Name: Birthdate:

Name: Birthdate:

Name: Birthdate:

Name: Birthdate:

CLUB MEMBERSHIP APPLICATION WAIVER

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 for membership, I, for myself and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, the North Coast Striders 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 this waiver.

__________________________________________________
Signature

__________________________________________________
Date

Note: An adult guardian or parent must sign for individuals under the age of 18.

Mail to: North Coast Striders, P.O. Box 1556, Ukiah, CA 95482