Roman Runners
Membership Application and Agreement

Please print this form, fill it out and mail to:

Kelly Moonen
1605 N. Madison St
Rome, NY 13440

Please enclose a check for $15 to cover the first year's dues.  Membership must be renewed each June.  Make checks payable to Roman Runners.

Agreement:  I, as a member of the Roman Runners, upon signing this agreement and making each year's dues, do agree that any incident, accident, or misfortune that may occur to me or any other member before, during or after a Roman Runners event is not the responsibility of the Roman Runners.  I further agree that no claims will be made against the Roman Runners, the Road Runners Club of America, or any sponsors of any event.

Member Signature: __________________________________________________________

Name (please print): _________________________________________________________

Address: _____________________________________________________________________

                  City                                          State                             Zip Code

Phone: ____________________________   Birthdate: _______________________________

Sex: ____________  E-mail address: ____________________________________________

Date Signed: ____________________  Witness: __________________________________