Orlando Front Runners & Walkers
Member Information Form

 

 

Name: _________________________________________________________________________

Street Address: __________________________________________________________________

City: _____________________________ State: ________ Zip Code: _____________

Home Phone: ___________________________________ OK to place on phone list?
Yes    No

 

Work Phone: ___________________________________ OK to place on phone list?
Yes    No

 

Email Address: __________________________________ OK to place on phone list?
Yes    No

 

May we e-mail you our monthly newsletter? (to conserve postage money) Yes No

 

Date of Birth:________________________

 

OFR Publication Permission:

Members’ names are sometimes published in our newsletter and we also put out a list
of members’ telephone numbers. Please check one of the following:

__   It OK to publish my full first and last name in the OFRW
newsletter and phone list.

__   Please only publish my first name and last initial in
the OFRW newsletter and phone list.

__   Please do not include me in the OFRW newsletter and
phone list.

OFR Photo Policy:

From time to time, we photograph Frontrunner member events.  If you are
camera-shy, please convey this to the photographer.  It is your
responsibility to inform those taking pictures that you do not wish to be
photographed.  We are happy to comply with your wishes.

 

 

Annual Membership Dues: (All memberships expire on May 1^st)

Standard Membership Rate: $20.00 ($15.00 after November 1^st

Couple Membership Rate (same household): $35.00 ($25.00 after November
1^st)

Note: A limited number of sponsored
memberships are available in cases of financial
hardship. Write “Sponsored Membership” on the
top of this form if you are requesting
a sponsored membership in OFRW. All requests for
sponsored memberships will remain confidential.

 

$1.25 of the dues amount is for a subscription to the Road
Runner Club of America’s quarterly magazine, Footnotes.

If you are a first-time member, how did you find out about Orlando
Front Runners & Walkers?

__   Newspaper

__   Other Member (please give name):
____________________________________

__   OFR Social Event

__   Other:
____________________________________

 

 

Liability Release:

In consideration of my participation in
the Orlando Front Runners, I, the undersigned, intending to be legally bound hereby, waive
and release for myself, my heir, executor, administrators and assigns, any and all rights
and claims for damages, demands and any other actions whatsoever, which I may have against
the Orlando Front Runners, its representatives and its supporters, successors and
assignees, arising out of my participation in any event sponsored or attended by the
Orlando Front Runners, including any and all injuries suffered by me as a result of my
participation in said events.

I verify that I have full
knowledge of the physical requirements and the risks involved in participation, and that I
am physically fit and have sufficiently trained for said events. Unless specifically
stated at the time of said events, I acknowledge that there will be no medical support
available.

 

 

Signature: _______________________________________________
Date: ______________

 

OFRW USE ONLY:  Amt Paid: ______  Date: _______
Rec’d by: _________  Membership #: _______