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Step 1 of 2 - Individual Membership Application |
First Name | Last Name
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Address 1
| Address 2
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City
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State / Province
Use 2 digit code for US and Canada otherwise, leave blank. | Country (only if outside of the U.S. and Canada)
Leave blank if address is within US or Canada. |
Zip / Postal Code
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Primary Phone Number
Required... please provide your primary number. | Other Phone
Optional... provide an alternate phone number. |
Email Address
Your active Email Address... check for accuracy. |
Member's Date of Birth
| Sex
Gender: M for Male, F for Female. |
Member ID: Are you a Current Member of Prairie State Road Runners?
Current members only... are you a current member, in good standing, with dues paid through the past calendar year? If so, you may qualify for free membership through the upcoming year. Leave blank if you're joining for the first time, or have let your membership lapse and are now rejoining Prairie State Road Runners. |
Special Class: Year that You Joined PSRR Club?
Renewing members only... please enter the Year (or approximate Year) that you originally joined the Prairie State Runners Club. Leave blank if you're joining for the first time. |
How did you hear about Prairie State Road Runners?
Optional... help make Prairie State Road Runners a better club by letting us know how you found us! |
Charitable Donation
Optional... please consider an additional charitable donation to help make Prairie State Road Runners a better club for our running community! |
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 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
the persons named in this waiver. Agree to waiver by checking here.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. |
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