Greater Philadelphia Track Club
Membership Form 2010
Member of the United States Track and Field Assoc Club (Club #08-0081)
Member of Road Runners Club of America (Club #2080)
Membership Form 2010
Member of the United States Track and Field Assoc Club (Club #08-0081)
Member of Road Runners Club of America (Club #2080)
Name_____________________________________________ (please print all info) Gender ________
Address_______________________________________________________________
City__________________________________ State____________ Zip________________
Home Phone____________________________________ Cell Phone_________________________________________
Birthdate_______________ E Mail_____________________________________________________________________
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Membership Fee is $25
Make check payable to Greater Philadelphia Track Club
Send to: Chuck Shields/ 1500 Ferndale Rd, Abington, Pa 19001
I, the undersigned, for myself, heirs, personal reps, and assigns intending to be legally bound, do hereby waive and release all rights,
claims,demands and /or causes of action against the Greater Philadelphia Track Club, and all of it's directors or reps for personal injury which I may
sustain during any club activity or practice, known to me or hereby discovered, and for any and all damages which I might occur now or in the future
arising from or out of my participation in club events. I also release GPTC for the use of my image for any promotional event associated pr used by
the club.
___________________________________________________________
Signature Date
Address_______________________________________________________________
City__________________________________ State____________ Zip________________
Home Phone____________________________________ Cell Phone_________________________________________
Birthdate_______________ E Mail_____________________________________________________________________
********************************************************************************************************************************************
Membership Fee is $25
Make check payable to Greater Philadelphia Track Club
Send to: Chuck Shields/ 1500 Ferndale Rd, Abington, Pa 19001
I, the undersigned, for myself, heirs, personal reps, and assigns intending to be legally bound, do hereby waive and release all rights,
claims,demands and /or causes of action against the Greater Philadelphia Track Club, and all of it's directors or reps for personal injury which I may
sustain during any club activity or practice, known to me or hereby discovered, and for any and all damages which I might occur now or in the future
arising from or out of my participation in club events. I also release GPTC for the use of my image for any promotional event associated pr used by
the club.
___________________________________________________________
Signature Date
