New Member Registration

RaceMT RRCA Running Club - 2012 Membership
PO Box 3144
Great Falls, MT 59403

After completing the form, you can either use your paypal account to pay by credit card or send $20 to the address above to confirm your enrollment in RaceMT RRCA Running Club. There will be a "REGISTER" button on the confirmation page that will take you to Paypal after completing this form.

Member Information

Fill in the information below to join Great Fall's only RRCA running club!

* First Name

* Last Name

* Address 1

Address 2

* City

* State

* Postal Code

* Phone (555-555-5555)

* Birthdate (mm/dd/yyyy)

* Shirt Size

* Renewing from 2011?

Yes	No - New Member

* Email Address

* Confirm email:

* Gender

Female

Male

* How did you hear about us?

* Contact me via phone with club information and announcements.

Yes

No

* Contact me via email with club information and announcements.

Yes

No

* I know that running and volunteering to work in club sponsored events are potentially hazardous activities. I will refrain from entering and running in club activities if I am not able and/or properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the event. I assume all risks associate with running and volunteering for club sponsored events, including but not limited to: falls, contact with other participants, the effects of weather including high 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 Road Runners Club of America, Race Montana 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 person named in this waiver. Race Montana has permission to include my name, address, telephone number and email address in any Race Montana directory and/or website to be used for club purposes only.

I have read and agree to the terms and conditions.

Yes

No

* Indicates Response Required