Last
Name_________________________________________First_________________________
Address
______________________________City____________________ST____Zip_________
Email ______________________
Day/Eve Phone_________________ Age ______
Sex________
Type of Membership: New____ Renewal____ Dues: Individual:
$25____ Family: $35____
If family membership, list others -
name/age____________________________________________
_________________________________________________________________________________
Membership is
from March to March. Dues are pro-rated for new members only
from October -February $10.00. Make checks payable to:
Phidippides
Track Club
Bring/Mail to: Stella Heffron, PO Box 2213, Parker, CO 80134
For information,
e-mail: stella@phidippides.com
In
consideration of acceptance of my membership in Phidippides
Track Club, I for myself,
my heirs,
administrators and assigns, hereby waive, release and discharge
any all rights and
claims for
damages against Phidippides Track Club and its officers and
agents for any claims
of damages in
any manner arising of resulting from my participation in any
activity conducted
by or under
the auspices of Phidippides Track Club.
Signature:_________________________________________________
Date: ___________