|
Print out this form, complete as required and return with payment to the address below: (Please make checks payable to the Pacesetters, Inc.)
PaceSetters, Inc.
PO Box 681
Menasha, WI 54952-0681
|
|
Membership Application
|
| Name: |
__________________________________________________________
|
| Address: |
__________________________________________________________
|
| City: |
_________________________ |
State:
|
___________ |
ZIP:
|
___________
|
| Phone: |
____________________________ |
|
|
| E-mail: |
____________________________ |
|
Birthdate: |
_____________ MM/DD/YYYY |
|
Gender: |
____ Male ____ Female |
|
Membership status:
Membership Level Desired - please check appropriate item:
|
|
____
|
NEW |
|
____
|
RENEWAL |
| Individual
Membership |
|
____
|
1 year
$20.00 |
|
____
|
2 year
$35.00 |
|
____
|
3 year
$50.00 |
|
____
|
4 year
$65.00 |
|
____
|
5 year
$80.00 |
|
____
|
Lifetime
$150.00 |
| Family Membership |
|
____
|
1 year
$35.00 |
|
____
|
2 year
$65.00 |
|
____
|
3 year
$95.00 |
|
____
|
4 year
$125.00 |
|
____
|
5 year
$165.00 |
Members are asked to assist at least one event per year.
Please indicate your choice below:
|
|
____
|
Fun
Run/Walk(s) - 2nd Wednesday of each Month |
|
____
|
MCF Scholarship Marathon (Fox Cities Marathon course backwards) -
March 17, 2012 |
|
____
|
Run for Home
10K Run/5K Run/Walk & Kid's Runs -
April 1, 2012 |
|
____
|
PaceSetters
XC Run - August 1, 2012 |
|
____
|
Cheesehead 1/2 Marathon & 5K Run/Walk
- August 25, 2012 |
|
____
|
St. Joseph Food Pantry 5K Run/Walk
- October 13, 2012 |
|
____ |
Marathon/half marathon training runs (Held weekly May
–
Sept) |
|
____
|
Community First Fox Cities Marathon
- September 21-23, 2012 |
|
|
Upon submission of this application, I agree
to assume all risks associated with
participation in any activity of the
PaceSetters Running Club. I release all
sponsors, officers, board members, employees
and any person assisting on a voluntary basis
from any claims of liability resulting from my
participation.
|
Thank You!
|
