Please print out and complete the following form (including by e0RncUCs

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									Green Bay Running Club Membership Application
Please print out and complete the following form (including signing and dating the waiver). Send
the completed form along with a check or money order made out to “Green Bay Running Club” to:

                                       Green Bay Running Club
                                  Jerry Feldhausen - Membership VP
                                         1524 Biemeret Street
                                         Green Bay, WI 54304

First and Last Name: ___________________________________________________________

Address: ____________________________________________________________________

City: ______________________________________State:___________ Zip Code: __________

Home Phone: __________________________ Cell Phone: ____________________________

E-mail Address: _______________________________________________________________

Date of Birth: ___________ Gender: Female _____                  Male _____

Membership Type (check one) ____1 Yr Individual $20     _____ 3 Yr Individual $50
____ 1 Yr Family $30 ____3 Yr Family $75    ____1 Yr Student $5

New: _______ Renewal: _______

If family membership other family members: (list additional on back)

_________________________ Date of Birth: ___________ Gender: Female ____ Male _____

_________________________ Date of Birth: ___________ Gender: Female ____ Male _____

_________________________ Date of Birth: ___________ Gender: Female ____ Male _____

I would like to be informed of GBRC volunteer opportunities                  _____Yes _____No

Waiver Agreement: Liability Release for any GBRC Event
PLEASE READ THIS DOCUMENT (THE “WAIVER AGREEMENT” CAREFULLY BEFORE
PARTICIPATING. THIS WAIVER AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS AND
WILL LIMIT OR ELIMINATE YOUR ABILITY TO BRING A FUTURE LAWSUIT.
I know that running/walking is a potentially hazardous activity. I should not run/walk unless I am medically
able and properly trained. I hereby certify that I am in good health and I have trained to run/walk with the
GBRC. I assume all risks associated with running/walking in any GBRC event including, but not limited to:
falls, contact with other members, the effects of weather, including high heat and/or humidity, traffic and the
conditions of the road, all such risks being known and appreciated by me. Having read this waiver and
knowing these facts and in consideration of your accepting my participation in GBRC events, I, for myself
and anyone entitled to act on my behalf, waive and release the Green Bay Running Club, Inc., its officers,
directors, volunteers and all states, cities, countries or other governmental bodies or locations in which
events or segments of GBRC events are held, all sponsors, their representatives and successors, from all
claims or liabilities of any kind arising out of my participation in any GBRC event even though that liability
may arise out of negligence or carelessness on the part of the persons named in this waiver.

I agree to the terms and conditions as outlined above

_______________________________________________                                     __________________
Signature                                                                           Date

								
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