Avondale Running Club Membership Application

First Name:_______________________

Last Name:______________________

Initial : _____

Address: _________________________________________________________________________

City:______________________________________________

State:_________

Zip:_________

Home Phone:___________________

Cell Phone:_________________

Best time to call ____________

Email:____________________________________

Work Phone optional: ___________________________________

Walk or Run before? ____ Yes ___  No  How many years ______________

Personal Fitness Objective in joining the Avondale Running Club:
___________________________________________________________________________________________
___________________________________________________________________________________________

Special interest or skill that may be of help to Running Club:
___________________________________________________________________________________________
___________________________________________________________________________________________

Membership Agreement

Read carefully before signing.  Your participation as an Avondale Running Club Member is based on your acknowledgement of and agreement
to the following conditions: Fitness Walking or Running is a potentially strenuous activity.  You should participate only if you medically able.  
Members assume all risks associated with walking or running with the Club, including but not limited to the effects of weather, traffic, course
conditions, falls, and contact with other walkers or runners.  The Avondale Running Club maintains Liability Insurance for its participation in
Club sponsored volunteer fund raising activities.

I consent to the use of my image in photos, video and audio recording, film, of my participation in all Avondale Running Club events. Yes___ No___

Signature _____________________________________________________  Date  _____________

Parent or Guardian If under 18 years of age
____________________________________________________________  Date  _____________

Emergency Contact:
Name  _______________________________________________ Phone______________________

For Office Use Only

Membership Dues: $15/year or $1.25/mo.

Paid :  $______________  Date: ____________________  Balance $___________________

Print and Mail to:
    Avondale Running Club
     P.O. Box 29238
     Cincinnati, Ohio  45229

Visit us on the World Wide Web at:  http://www.avondalerunningclub.com