This document is a membership application form for the SWVRRC club for the year 2011. It requests the applicant's contact information, date of birth, gender, and type of membership being applied for - new or renewal. Family memberships list additional family members and their dates of birth. The form is signed and includes a space for the amount enclosed and instructions to make checks payable to SWVRRC.
This document is a membership application form for the SWVRRC club for the year 2011. It requests the applicant's contact information, date of birth, gender, and type of membership being applied for - new or renewal. Family memberships list additional family members and their dates of birth. The form is signed and includes a space for the amount enclosed and instructions to make checks payable to SWVRRC.
Original Description:
Membership Application for the Sourthern West Virginia Road Runners Club
This document is a membership application form for the SWVRRC club for the year 2011. It requests the applicant's contact information, date of birth, gender, and type of membership being applied for - new or renewal. Family memberships list additional family members and their dates of birth. The form is signed and includes a space for the amount enclosed and instructions to make checks payable to SWVRRC.
This document is a membership application form for the SWVRRC club for the year 2011. It requests the applicant's contact information, date of birth, gender, and type of membership being applied for - new or renewal. Family memberships list additional family members and their dates of birth. The form is signed and includes a space for the amount enclosed and instructions to make checks payable to SWVRRC.
C/O Tom Davis , Treasurer P.O. Box 1157 Athens , WV 24712 Circle Type : * New * Renewal PRINT Name _______________________________Print email _____________________________ PRINT Address____________________________________________________________________ PRINT Address ____________________________________________________________________ PRINT City__________________________________ State __ __ Zip __ __ __ __ __ Telephone Number ( __ __ __ ) __ __ __ - __ __ __ __ Date Of Birth: mm/dd/yy __ __ /__ __ / __ __ Circle Sex: *Male *Female Age: _ _
CLUB MEMBERSHIP YEAR IS: JANUARY 1 -- DECEMBER 31
NEW or RENEWAL: Students $8.00 Individuals $12.00 Family* $15.00
* FAMILY APPLICANTS --- please list EACH “additional” family member below:
PRINT Name ____________________________ DOB ___ / ___ / ___ Circle M F
PRINT Name_____________________________DOB ___ / ___ / ___ Circle M F PRINT Name_____________________________DOB ___ / ___ / ___ Circle M F PRINT Name_____________________________DOB ___ / ___ / ___ Circle M F PRINT Name_____________________________DOB ___ / ___ / ___ Circle M F