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!