Membership Form

Join the North Shore Striders (or renew your membership) for 2017!

Note: Already a member? Just need to pay? Already filled out your information through this form recently? You, friend, can skip to the payment form!

First Name*
Last Name*
Email*
Address
City
State
Country
Zip Code
Home Phone
Work Phone
Mobile Phone
Primary Phone	Home Work Mobile
Renewal or New Membership*	New Renewal
Membership Type*	Single $25 Family $35 Upgrade from Single to Family $10 DCA Single DCA Family DCA Single Upgrade to Family $10 DCA is Dues Credit Awarded. This pertains to USATF members applying for membership credit with NSS.
USATF Number	For dues credit. Please give number for current year.
Volunteering Interest	Race Manager Race Assistant Club Event Publicity/Web other:
Gender*	Female Male
Birth Date*	mm/dd/yyyy
Age*
Age Division
Member Comments
Release/Waiver Agreement*	I accept waiver I know that running is a potentially hazardous activity. I should not enter and run in club activities unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely complete the run. Knowing these facts, and in consideration of your accepting my entry fee, hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf, I agree not to sue, and waive, release, and discharge the North Shore Striders, including their agents, employees, assigns, or anyone acting on their behalf, from any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of, or in the course of, my participation in any events. This Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen or unforeseen, known or unknown.
Captcha*	1 × 4 = ? This is to cutdown on spam submissions. Please put in answer to math problem!

If you need to add family members, just resubmit the form for each family member you’re adding.

If you have any problems with this form, please contact Andrew Moore.

Membership Form

North Shore Striders

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