|Step 1 of 2 - Family Membership Application|
|Primary Member's First Name|
|Address 1||Address 2|
|State / Province|
Use 2 digit code for US and Canada
otherwise, leave blank.
|Country, if outside of the U.S. and Canada|
Leave blank if address is in US or Canada.
|Zip / Postal Code|
|Primary Member's Phone Number|
Required... please provide your primary phone number.
Optional... provide an alternate phone number.
|Primary Member's Email Address|
Your active Email Address... please check for accuracy.
|Primary Member's Date of Birth||Sex|
M for Male, F for Female.
Special Class: Year that You Joined PSRR Club?
Required... please enter the Year (or approximate Year) that you originally joined the Prairie State Runners Club.
How did you hear about Prairie State Road Runners?
Optional... help make our club better by letting us know how you found us.
Total Number of Members for Your Family (2 minimum to 6 maximum)
Total number of members for your family... you plus the number of your family members.
Example... Let's say your family is made up of you, your spouse, and two children.
You + Spouse + 2 = 4
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 the 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, 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 Road Runners Club of America, the Prairie State Road Runners 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 Agree to waiver by checking here.
the persons named in this waiver.
By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process.