Membership

Longview Running Club
P.O.Box 150555
Longview, TX 75615

You are invited to become a member of the Longview Running Club. Dues are $15 for a runner, $20 for a family membership which includes spouse and children up to age 21, and $10 for students (not in a family membership) and retirees. Membership for the year is due January 1, and is half price if joining after June. Please copy and complete this form and mail it to the above address with your check payable to Longview Running Club.

NAME:_____________________________________________ DATE:__________

ADDRESS:__________________________________________ RENEWAL:______

CITY:____________________ STATE:______ ZIP:______ NEW MEMBER________

PHONE:_________________ PLACE OF EMPLOYMENT:_____________________

AGE:______ BIRTHDATE:________ MALE:____ FEMALE:____ MARRIED:_______

AVERAGE MILES RUN PER WEEK:__________ BEST 5K:______ BEST 10K:_____

RUNNING GOALS:_____________________________________________________

SPOUSE'S NAME:__________________________ DOES SPOUSE RUN?:________

CHILDREN'S NAME(S):_________________________________________________

FOR FAMILY MEMBERSHIP PLEASE FILL OUT THIS SECTION

NAME:_____________________ AGE:_____________ BIRTHDATE:_____________