Twin City Track Club Membership Application

(Key in values on the screen, print the form, sign it, and mail it with your check.
Note that middle initials are always helpful, we have several members with similar names.)

NameBirth Date
Sex Age Address
City State Zip Code
Home Phone Work Phone
Occupation E-Mail
Running interest
Other Family Members Joining: (list name, birth date, and sex) Dues





Renewal New Member (I'm paying dues through ) Total Dues

WAIVER: I know that running and volunteering to work in club races are potentially hazardous activities. 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 compete the run. I assume all risks associated with running and volunteering to work in club races including, but not limited to, falls, contact with other participants, the effects of the 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 the Road Runners Club of America, the Twin City Track Club, Inc., and all sponsors, their representatives and successors from all claims of 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.

Member Signature _____________________________________________________________________

Parent's Signature if under 18____________________________________________________________

Signature of other individuals to be covered _______________________________________________

 NEW MEMBERS: Dues for a primary member are $20.00 for one year, $45 for three years. Additional family members in the same household are $1.00 for per year or $3 for three years.

Send application and dues to TCTC Membership, PO Box 692, Winston-Salem NC 27102. Make checks payable to Twin City Track Club.