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CMS Membership Application
Please Print Clearly
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Name:
_____________________________________________
New: ____
Renewal: ____
M ____
F ____
Mailing address:
_________________________________________________
Town:
_____________________________________
State: __________
Zip code:
___________-___________
Date of birth:
_____ / _____ / _____
Telephone numbers(s)
________________________________________________________
Email address:
________________________________________________________
Additional Family Members
Name(s)
M/F
Date of Birth
______________________________________
____ ____ / ____ /
_____
______________________________________
____ ____ / ____ /
_____
______________________________________
____ ____ / ____ /
_____ |
Interest
Areas
If you have an interest
in one or more of the following activities, please let CMS know by
circling the appropriate numbers:
- Race Volunteer - Take a day off from racing and put in
a day on the other side of the finish chutes.
- Race Director
-
Have an idea for a new race or how to improve an existing
one? Here's your chance to make it happen.
- Timing & Scoring Crew Chief
- You will be trained on how to oversee the mechanics of
timing /scoring a road race.
- Board of Directors – 8 of the 13 Board of Director.
positions are filled by election. Any member can run for these
positions.
- Race reporting and Newsletter /Website staff – Going
to a Race ? Write a story and become a published writer.
- Multisport – Are you interested in duathlons or
triathlons and want to find out about the multisport team?
- Relay Teams –Teams are periodically assembled for
multisport and running relays. Specify your interests:
run,bike,swim.
- Web Guy...web page editing, publishing, design.
Other:
_________________________________________________________
Membership 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 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
Central Massachusetts Striders, 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.
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Signature(s) (required):
___________________________________________________________
Parent/guardian
signature if under age 18 ___________________________________________________________
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Individual |
Family |
Printed Newsletter
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Total |
| 1 Year Individual:
___ $20 |
Family : ____$25 |
No Newsletter Discount:___-$5 |
Total: _____ |
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2 Year Individual: ___ $40 |
Family : ____$50 |
No Newsletter Discount:___-$10 |
Total: _____ |
| 3 Year Individual: ___ $60 |
Family : ____$75 |
No Newsletter Discount:___-$15 |
Total: _____ |
Membership Dues
Please check the appropriate options
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Membership term runs from date received.
| Please send check/money order and application to:
Central Mass Striders,
PO Box 922,
Worcester, Ma 01613-0922. |
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