Faerber's Flyers

Membership Application

Name:________________________________________________________________________

Address:______________________________________________________________________

City:_________________________ State:_______________ Zip Code:___________________

Contact Numbers: Home________________ Work_____________________________

E-Mail:_______________________________________ Fax:____________________________

Date Of Birth:__________________ Occupation:_____________________________________

Membership applying for_______________ Amount Paid_________ Date_________________

Regular ($50) $1.25 of dues goes towards the issue of Road Runners Club of America FootNotes Magazine

Student ($25) Must be at least a half-time student at an accredited Hawaii campus.

Includes one race entry fee. No voting privileges.

Inactive/Non-Resident ($25) Includes social activities. No race entry fee or voting privileges.

Please mail this application along with your membership fees to;

Faerber's Flyers

P.O Box 4266

Honolulu, Hawaii 96812-4266

WAIVER

In consideration of your accepting my application, I, intending to be legally bound for myself, my heirs, executors and administrators, do hereby release and discharge the Faerber's Flyers, University of Hawaii, Road Runners Club of America and any and all sponsors and their respective officers, directors, agents and employees jointly and severally from any and all liability for illness, injuries and damages I may suffer arising out of or resulting from my participation in this organization. I hereby represent and certify that I am over 18 years of age and that I have carefully read the foregoing release and know the contents thereof and that I have signed it of my own free will.

______________________________________________ ________________________

Members Signature Date

EMERGENCY DATA

In Case of Emergency Contact_____________________________________________________

(Full Name)

Relationship___________________________________________________________________

Contact Number(s)______________________________________________________________