APPLICATION FOR BLUE  SPRINGS RUNNERS MEMBERSHIP 

Benefits of membership:
Quarterly Blue Springs Newsletter with list of weekly runs
Notification by email of any last minute run changes
Current news and info about running in the Blue Springs and surrounding areas
Discount at Garry Gribble Sports
Quarterly issues of the RRCA magazine "FOOTNOTES".

Fun, fun, fun.

NAME: _____________________________________________ MALE _______ FEMALE_______

STREET: ___________________________________   CITY____________________________

STATE: ______ ZIP: __________ EMAIL: _________________________________________

DAY PHONE: ___________________________   HOME PHONE __________________________

OCCUPATION ________________________________    BIRTH DATE ____________________

CIRCLE APPLICABLE CATEGORY: $15 SINGLE MEMBERSHIP $20 FAMILY MEMBERSHIP
 
The following memberships are tax deductible & will be used for ongoing programs
of the Blue Springs Runners:
  
GOLD  $100 ______       SILVER  $50 _______      BRONZE  $25  ________

(IF FAMILY, LIST OTHERS:_________________________________________ DOB__________

                        _________________________________________ DOB__________

SIGN BELOW AND MAIL TO BLUE SPRINGS RUNNERS, PO BOX 751, BLUE SPRINGS, MO 64013,
OR GIVE TO A BLUE SPRINGS RUNNER OFFICER.

WAIVER: I know that running and volunteering in club events are potentially 
hazardous activities. I assume all risk associated with these activities.
I hereby waive and release, for myself and anyone entitled to act on my 
behalf, the Kansas City Track Club, the Road Runners of America, and all 
sponsors and race officials from all claims of any kind arising out of my
participation in club activities. I understand that a portion of my dues is
used to sent to RRCA and entitles me to receive the quarterly RRCA newsletter.

SIGNATURE __________________________________________________ DATE_____________