 Lake Grapevine Runners and Walkers Club
Membership Application
Name__________________________________________ New Member _____ Renewal___
Mailing Address______________________________________________________
City/State/Zip________________________________________________________
Phone (Home)_________________________________
E-Mail Address ______________________________________________
_____ Male ___ Female Age__________Date of Birth____________________
Additional Family Member Names
___________________________ M__F__DOB_________
___________________________ M__F__DOB_________
___________________________ M__F__DOB_________
___________________________ M__F__DOB_________
It's OK to publish the above info in the club directory
(Check one) _____Yes ____No
How did you hear about the club ________________________________________
I know that participating and volunteering to work in club events can be potentially hazardous. I should not enter into club activities unless I am medically able and
properly trained. I agree to abide by the decision of event officials relative to my ability to safely complete the event. I assume all risks associated with running, walking
and volunteering to work in club events including, but not limited to falls, contact with other participants, the effect of weather, including high heat and/or humidity,
the condition of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiverand knowing the 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 Lake Grapevine Runners and Walkers, Inc.,
the Road Runners Clubs of America, and all sponsors, their representatives and successors from all claims of liabilities of any kind arising out of my participation in club
activities even though that liability may arise out of negligence or carelessness on the part of the persons named in the waiver. I understand that bicycles, baby joggers,
skateboards, roller or inline skates, animals and radio headsets are not allowed in the races and I will abide by this guideline. I grant permission to all of the foregoing to
use any photographs, motion pictures, recordings or any other records for any legitimate purpose.
Signature___________________________________ Date_____________________
Membership Fee: ____Individual ($20) ____Family ($30) (Check here if you need two membership cards.______ )
All memberships good for 1 year
Mail Applications and Check to:
Lake Grapevine Runners and Walkers Club
P.O.Box 2982, Grapevine, Tx. 76099
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