Membership Application

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Please complete the following information and click Submit at the bottom of the form.  You will be prompted for payment information on the next page.  All memberships expire on June 30.  Applications submitted between March 1 and June 30 will be valid until June 30 of the following year.  Applications submitted July 1 through February 29 will expire at the next renewal cycle.

Check One:

New Member(s) Renewing Member(s)

Check One:

Individual Household Senior (55+) Senior Household Student (full-time)
$30.00 $40.00 $20.00 $30.00 $20.00

Optional: Additional tax-deductible contribution to benefit scholarship fund -

Name Date of Birth Sex Male Female
Name Date of Birth Sex Male Female
Name Date of Birth Sex Male Female
Name Date of Birth Sex Male Female

Contact Information:

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Please contact me/us with information about becoming part of the following team(s):

Publicity    Membership   Events       Fundraising	Volunteers

How did you hear about the ORC?


Upon submission of this application, I agree to assume all risks associated with participation in any activity of the Orlando Runners Club, Inc.  I release all sponsors, officers, employees, and any person assisting on a volunteer basis from any claims o liability resulting from my participation.

Signature:                                                                                            Date:

             -- mm/dd/yy