Rock River Striders Membership Application
Name:  Birthdate: 
Address:  Sex: Male Female 
City:  State:  ZIP: 
Phone:  Email: 
Check one: New Member ____Renewal         Check one: Runner ___Walker ___
Membership Options: 1 year 2 year 3 year
Single $10 $18 $26
*Family $15 $28 $40
Sponsor $30 $55 $80
Student $5
*Family Membership: Limited to immediate family members at same address including children 18 and under. Please list names and ages:

Make checks payable to "Rock River Striders" and mail to P.O. Box 4271, Rock Island, IL 61206-4271
Are you interested in volunteering for club events? yes no 
RRS Races Newsletter Membership Computer Other 
Fill out this form, print it, and send it with your check or money order to:
  Rock River Striders - Membership
  P.O. Box 4271
  Rock Island, IL 61206-4271
We apologize for the inconvience of having to mail a check!