Plano Pacers Membership Application

 

To become a member of the Plano Pacers Running Club, or to renew an active membership, please complete this form and send a check in the amount for $35 for family or $25 for individual annual membership.

 

        r  Individual $25                               r  Family $35

 

                                        r  New member                      r   Renewal

 

 

   Name ____________________________________________________________________

 

   Address __________________________________________________________________

 

   City _________________________________                       State _______ Zip __________

 

   Home phone _________________________ Work/Cell phone________________________

 

   E-mail address _____________________________________________________________

 

   Birthday ______/______/______

 

Waiver of liability:

In consideration of membership with the Plano Pacers, I, for myself, and my minor children, and anyone entitled to act on my behalf, forever release and discharge the Plano Pacers, its officers and members, any sponsors, volunteers, and their representatives from all claims and liabilities of any kind, whether injury, death, or property damage, arising out of my or my  children’s participation in Plano Pacers’ activities.  I understand and assume all risks associated with running and participating in the Club activities, but not limited to falls, contact with other participants, the effects of weather, the conditions of the course, and vehicles on the course, all such risks being known and appreciated by me.  I will assume and pay for any medical and emergency expenses in the event of accident, injury, illness, or other incapacity regardless of whether I have authorized such expense.  I understand that bicycles, skateboards, baby strollers, roller blades or skates, animals, and headsets are not allowed in Club races and will abide by this guideline.

I have read the above and agree to it.

 

 

 

Signature ______________________________________Date ______________

 

              Send the completed form with check made out to Plano Pacers to

              Plano Pacers, PO Box 867136, Plano, TX 75086-7136