RED RIVER ROAD RUNNERS, INC.

MEMBERSHIP APPLICATION

Date: ________________ Membership Status:

New ___ Renewal ___

Individual: $12 Family: $18 Student: $5

($1.25 of this amount is for a subscription to the RRCA's quarterly magazine Footnotes for one year)

NAME: __________________________________________________________

ADDRESS: ________________________ CITY: _____________ STATE: ____ ZIP: ______

DATE OF BIRTH: __________________ SEX: ______ HOME PHONE: _______________

OCCUPATION: ____________________________ BUSINESS PHONE: _______________

E-MAIL ADDRESS: ______________________________________________

ADDITIONAL FAMILY MEMBERS:
NAME _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________	SEX ____ ____ ____ ____	BIRTHDATE ______________________________ ______________________________ ______________________________ ______________________________

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RRCA 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,

Signature: _____________________________________ DATE: ________________

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Mail this application to:

Red River Road Runners, Inc. PO Box 37691 Shreveport, LA 71133-7961

For further information contact: Jenneth Merriman at (318) 925-2694 or Steve Gehrig at (318) 861-0348