Sullivan Striders
Running & Walking Club 2012 Membership
January 1 - December 31, 2012

Name: ______________________________  Date of Birth: ________________________

Street: ______________ City: ________________ State: __________ Zip Code: _______

Phone Number: ______________________________  Email Address: ________________

Membership	Price	Check one	New/Renewal
Individual	$18.00
Child w/Registered adult	$5.00
Couples	$30.00
Family	$35.00
70 & Over	FREE

Club Membership Waiver

I know that running and volunteering to work in club events are potentially hazardous activities. I should not enter and run in club activities unless I am medically able and properly trained.  I assume all risks associated with running and volunteering to work in club races and I waive and release the Sullivan Striders Runners Club, the Road Runners Club of America, municipalities where events are held, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities.

Signature: ___________________________________________________ Date ____________

Parent’s signature if <18 years old: ________________________________  Date ____________

Mail to:
Sullivan Striders
PO Box 702
Rock Hill, NY  12775

For more information contact Myriam Loor at (845) 866-1345

---

Further information:
Explore this website's links or contact webmasters Dennis Toscano or Brian Cavanagh