Arkansas Ultra Running Association, RRCA Club

2014 MEMBERSHIP APPLICATION

* Please print *

Name ______________________________________

Sex: M F Age: ______ Phone ________________

E-mail address _______________________________

Address _______________________________________
City ___________________ State _______ Zip ________

Do you wish to participate in the 2014-2015 AURA Ultra Trail Series? ____

Please provide information on other running family members at your address:

First name Last name age e-mail address UTS registration?

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Note: Club membership with this application is effective through June 30, 2015

Annual dues for the AURA (this includes all family members):	$12
Option to receive newsletter via USPS, instead of by e-mail (add $13):	_____
Ultra Trail Series registration fee(s) (add $10 for each participant):	_____
Optional additional donation to the AURA (a 501(c)(3) organization):	_____
Total amount:	_____

Make checks payable to: Arkansas Ultra Running Association

41 White Oak Lane

Little Rock, AR 72227

Membership WAIVER (please read!)

I recognize that running and related activities are potentially hazardous. I assume all risks associated with participation in club activities, including but not limited to running, racing, volunteer work, fun runs and meetings. Having read this waiver, I voluntarily agree for myself and anyone acting on my behalf, to release the Road Runners Club of America and Arkansas Ultra Running Association, RRCA Club, and its officers and members, from all claims or liabilities of any kind arising from my participation in club related activities.

Signature(s) of adult member(s) / Date