Norfolk County Pacers Running Club 2007 Membership Form   Promoting the sport of running for fun, fitness and community Return to: 4 Jack’s way, Franklin, Massachusetts 02038   Name:_______________________________________________  Birth Date:__________________   Sex:  F___ M___   Address:_______________________________________  City:____________________________  State:____ Zip____   Home Phone:_________________  Work Phone:________________  E-mail:_________________________________   T-Shirt Size(s) Adult X-Large ___ Large___ Medium___ Small___    Child Large ___ Medium ___ Small ___   If this is a family membership, please list the names, sex, and birth dates of family members:   Name                                        Sex                   Birth Date  ________________________________                ____                 ______________________  ________________________________                ____                 ______________________  ________________________________                ____                 ______________________     Type of Membership:  New____   Renewal____      Membership period expires March 31, 2008 All dues are $5 off prior to March 1, and ½ listed price after Sept. 1, 2007.                                                                         Adult ($35 per year ) ______                                     Family ($50 per year) ______       Please make checks payable to: Norfolk County Pacers   Check any Pacer activity for which you would like to volunteer            Volunteer For A Specific Activity: ____  Membership ____  Team Race participation planning ____  Corporate sponsorship ____   Community and Charities ____   Pub Run ____   Weekly Fun Run’s ____   Other (list) ___________________ Club Membership Waiver:  I know that running and participating in anyway in club-sponsored events are potentially hazardous activities.  I should not take part in club activities unless I am medically able and properly trained.  I assume all risks associated with running and participating in club activities such as fun runs and 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 Norfolk County Pacers, and all sponsors, their representatives and successors from all claims or 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 persons named in this waiver. Signature:________________________________________________________   Date:_____________  Parent’s Signature if under 18:__________________________________________________     For additional information e-mail ncpacers@comcast.net