Name    ___________________________________________________________
Age     ________________________  D.O.B. __________________________
Address ___________________________________________________________
City    ________________________  State __________  Zip ___________
Phone   ___________________________________________________________
E-mail  ___________________________________________________________

Volunteer Interests:

       Race Volunteer        Photography 
       Newsletter            Membership 
       Social Events         Board Member 

Waiver of Liability and Statement of Fitness:
In consideration of my application being accepted, I intend to be legally bound,
to hereby, for myself, my heirs and executors, waive release and forever discharge
any rights and claims for damages which I may have hereafter accrue to me against the
South Florida Striders, its respective officers, agents, representatives, sponsors
and successors of any and all damages or injuries sustained by me or my equipment
which may occur directly or indirectly from participation in club activities. 
I attest that I am in proper physical condition to participate in club activities.

Signature _______________________________________  Date ___________

Signature of Parent or Guardian if athlete is under 18 years of age:
___________________________________________________________________

Annual Membership Dues (Choose One):
  Student(18 & under) - 1 year ....................... $10.00
  Student(18 & under) - 2 years ...................... $18.00   
  Individual Membership - 1 year ..................... $20.00
  Individual Membership - 2 years .................... $34.00
  Family Membership - 1 year ......................... $25.00
  Family Membership - 2 years ........................ $42.00
     Family members' names:
     _______________________________________________________________ 
     _______________________________________________________________
 
Please make check payable to: South Florida Striders, Inc. 
Mail to: PO Box 822233, South Florida, FL 33082-2233