South Florida Striders Running Club
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  Running Class and Membership Application

Name    __________________________________  Male  ____  Female _____  Age ___
Address ___________________________________________________________ City __________________________________ State __________ Zip ___________ Home Phone _____________________________ Cell ___________________________ E-mail _____________________________________________________________________ Volunteer Interests:
       Race Volunteer        Photography 
      Newsletter           Membership
      Social Events     Board Member Please Read and Sign Waiver: I know that running and walking are potentially hazardous activities. By entering this program, I am taking responsibility for medical clearance and for being physically fit and properly trained to participate in this program. I agree to abide by any decisions of program officials relative to my ability to safely complete the training program. I assume all risks associated with running, but not limited to my own fitness and health condition, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the condition of the road or track, all such risks being known and appreciated by me. Further, I agree to notify the coach if my condition changes, i.e. pregnancy, cancer, heart condition, etc, and the coach thereby reserves the right to release me from this coaching contract. Having read this waiver and knowing these facts, and in consideration of you accepting my entry, I for myself and anyone entitled to act on my behalf, waive and release Robert Dozoretz, The South Florida Striders, The City of Hallandale Beach, Hallandale Beach High School and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this program though that liability may arise out of negligence or carelessness on the persons named in this waiver and other organizations. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings or any other record of this program for any legitimate purpose.
Signature _______________________________________  Date ___________

Annual Membership Dues:
  Individual Membership - 1 year ..................... Included in $70.00 program fee

Please make check payable to: South Florida Striders, Inc. 
Mail to: PO Box 822233, South Florida, FL 33082-2233 
South Florida Striders - P.O. Box 822233 - South Florida, FL 33082-2233
954-442-0129