Chattanooga Track Club Membership Application

 Please make check payable to:  Chattanooga Track Club, P. O. Box 11241, Chattanooga, TN  37401

CTC membership dues are on a calendar basis (Check One) | New |  Renewal |

For new members, dues are prorated on the quarter the member joins, please check the one that applies to you:

Individual:    $24  (Jan-Mar) |  $18 (Apr-June) |  $12 (July-Sept) | $ 6 (Oct-Dec)

Family:          $36  (Jan-Mar) |  $27(Apr-June) |  $18 (July-Sept) | $12 (Oct-Dec)

Students:      $18  (Jan-Mar) |  $13.50 (Apr-June) | $ 9 (July-Sept) |  $4.50 (Oct-Dec)

      

Name __________________________________________ Birthdate ________ Name _________________________________________Birthdate ________

 

Name ___________________________________________Birthdate___ _____ Name _________________________________________Birthdate ________

 

Street _________________________________________________City __________________________ State_________ Zip _____________

 

Home Phone (___) _____-________ Work Phone (___) ____-_____  Email #1._____________________________Email#2______________________________

 

Members Release:  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 to safely 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 affects of the weather, including high heat and / or humidity, the conditions of the road and traffic on the coarse, all such risks being known and appreciated by me.  Having read this waver 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 Road Runners club of America, the Chattanooga Track Club, 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_________Signature______________________________________ Date  ______________

 

Signature __________________________________________ Date _________Signature _____________________________________ Date  ______________