Membership Application

Make checks payable in US funds to:

GBRC
P.O. Box 683
Bellingham WA 98227


Name(s)_________________________________________________________

New Member_________________   Renewal___________________________

Address_________________________________________________________

City/State/Prov. ___________________________  Zip_______________

Phone_______________________ Date(s) of Birth___________________

E-mail__________________________________________________________

Type of Membership:

[ ] Individual  [ ] Couple  [ ]  Family   Newsletter
(number)_____________________

Club Fees:
Membership: 
Single - $16.00; Couple - $24.00; Family - $32.00; Youth - $10.00;
Newsletter only - $9.00

(After June)
Single - $10.00; Couple - $15.00; Family - $20.00; Youth - $6.00;
Newsletter only - $5.00

(Non - Member) Run Entry Fees:
18 years & under - $2.00 (US) / $3.00 (CDN; 19 yr & up - $4.00 (US) /
$5.00 (CDN)

Membership Agreement:

I / we  will help with the __________________________________________
(indicate month) race. The club has no medical coverage for participants.
Therefore, it will be your resposibility to provide coverage for yourself
if wanted. I / we (sign)____________________________________  understand
the above statement
 and will not hold the BELLINGHAM RUNNING CLUB or any member responsible
for any injury that might occur durring any club sponsored event.


(Signature)____________________________________________


(date)____________________________________