Lakeland Runners Club Inc., Box 1484, Lakeland, FL. 33802   www.lakelandrunnersclub.com

Lakeland Runners Club Membership Form…“a club for runners of all abilities"

Name _______________________ Email __________________

Address _____________________ Phone __________________

_____________________________ Zip __________________ DOB_____________

Membership Action Renewal _____ New Member _____

1 Year Membership Fees (Free for Track Coaches)

Student = $5      Individual = $20      *Family = $30

*Family Member Names:__________________________________________________________
Amount Enclosed = _______________
Check Payable To; Lakeland Runners’ Club, Inc.

Mail to: L.R.C. - P.O. Box 1484 Lakeland, FL 33802

From the Items Below, Circle All that Apply…

Interests?
Walking Fun Run 5k Run 10k+ Run Marathon
Level?
Newcomer / Moderate Experience / Experienced
Willing To Help –Events?
Yes No

Waiver…
I know that running and volunteering to work in a club race 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 risk associated with running and volunteering to work in club races including, but not limited to falls, contact, the affect of weather, the conditions of the road and traffic, all such risk 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, myself and anyone entitled to act on my behalf, waive and release the Lakeland Runners Club, Inc., the Road Runners Club of America 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 arise out of negligence or carelessness on the part of the persons named in this waiver.

Signed _________________________________________________ Date _____________
(Parent/Guardian IF under 18 yrs old)