To Join the West Virginia Track Club:

Please print, complete and sign this page and return it with dues to:
                        West Virginia Track Club
                        PO Box 4159
                        Morgantown, WV 26504
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2010 West Virginia Track Club membership

NAME:____________________________________________________________________

ADDRESS: ________________________________________________________________

               ________________________________________________________________

Telephone:  ________________________          Cell: __________________________

E-Mail Address: ___________________________________________________________
Would you like to receive our newsletter electonically?      Yes    or    No     (circle One)

Type of Membership:       New ___________         Renewal ___________
             Individual ($15) _________   Family ($25) _______   Student ($10)_________

FAMILY MEMBERSHIP NAMES:                            STUDENT MEMBERSHIP:

___________________________________          High School_______  College _______
___________________________________          School Name: ____________________
___________________________________
___________________________________

APPLICATION WAIVER:

I know that running and volunteering to work in club races are potentially hazardous  activities.   I
should not enter and run in club activities unless I am medically able and properly trained.  I agree
to abide by any decision of a race official relative to my ability and safety to complete the run.  I
assume all risks associated with running and volunteering to work in club races including, but not
limited to, falls, contact with other participants, the effects of weather, including high heat and
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 knowng these facts, and in consideration of your
acceptance of my application for membership, I, for myself and everyone entitled to act on my
behalf, waive, the Morgantown Roadrunners/West Virginia Track Club and all sponsors, their
representatives and successors from all claims or liabilities of any kind arising out of my participation
in these clube 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 signature if under 18