GULF COAST RUNNERS

MEMBERSHIP APPLICATION

RESPOND TO:

GULF COAST RUNNERS

BOX 8636

NAPLES Fl. 34101

RECEIVE AS A MEMBER

CLUB NEWSLETTERS

ORGANIZED TRAINING RUNS

POT LUCK DINNERS AND PARTIES

DISCOUNTS ON SELECTED RACES

DISCOUNTS AT NAPLES ON THE RUN

WWW.GCRUNNER.ORG

NAME_____________________________________________DATE OF BIRTH___________________

ADDRESS___________________________________________________________________________

CITY___________________________________________________ STATE________ ZIP__________

HOME PHONE________________________ E-MAIL _______________________________________

PLEASE CIRCLE THE MEMBERSHIP DUES YOU ARE PAYING

MEMBERSHIP LENGTH

STUDENT

Under 18

INDIVIDUAL

FAMILY

GOLD MEDAL CLUB

BENEFITING YOUTH DEVELOMENT

1 YEAR

$10

$20

$25

$100+

3 YEAR

$55

$70

The Gulf Coast Runners membership is an annual membership that renews on the month joined

MEMBERSHIP LENGTH__________AMOUNT PAID_________________CHECK NUMBER___________

FAMILY MEMBERSHIP INFORMATION( ONLY NEEDED FOR FAMILY MEMBERSHIPS)

SPOUSE________________________________________________________________BIRTHDATE____________

CHILD ________________________________________________________________BIRTHDATE____________

CLUB MEMBERSHIP APPLICATION WAIVER

I know that running and volunteering to work at club races are potentially hazardous activities. I should not 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 gulf Coast Runners 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 rise out of negligence or carelessness on the part of the persons names in the waiver.

Signature of Applicant ____________________________________________________________ date _________________________________________________

Parents Signature if applicant is under 18