UTAH RUNNING CLUB

URC Event/Club Membership Registration Form
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E-mail (if pre-paid or free) to: UtahRunningClub@gmail.com

or mail to:
Mary Ann Schauerhamer
265 E 200 N Apt. 21, Provo, UT 84601
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Please make checks payable to “Mary Ann Schauerhamer”

BE SURE TO ANSWER EVERY QUESTION.  If you don’t think it applies to you, please write “N/A” next to the question.  Thankyou!
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Date of event:

Distance of event:

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Name:

Full Mailing Address:

Gender:    M  or   F

E-mail:

Phone: (       )        -

How did you find out about this race? (please be very specific so we can be sure to thank them)

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Cost of your event (based on date of registration) or if free write “free”:

High school, pre-collegiate, and collegiate athletes:

Are you planning on trying out for a NCAA athletic team in high school or college or are you currently on a team?

If so, which school team are you currently on?

Add $10 to join Utah Running Club (optional):

FREE ENTRIES:

If you volunteered for or contributed to URC in some way to earn a free entry, what did you do?

Name and location of business where you work where the Utah Running Guide flyer/poster is displayed for a free entry:

DISCOUNTED ENTRIES:

Date of the last training run you attended in the previous year for a free entry:

When did you pay to become a member of URC?

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Total paid/payment form (ie. check, cash, money order, or if free, write “Free”):
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In consideration of my entry in any of the events of the Utah Running Club, I do hereby for ourselves, heirs, executors, administrators and assignees,  waive and release any and all rights, claims and actions for damages that we or any of us may have, or that may hereafter accrue to us or any of us, against any and all persons, organizations, and entities associated directly or indirectly with the event, arising out of or in connection with my entry in, travel to, participation in, and returning from the URC event.  I attest and verify that I am physically fit and sufficiently trained to participate in this event.  I also give my permission for the free use of my name and/or pictures in broadcasts, telecasts, newspapers, posters, advertising, etc.  I understand that the entry fees are non refundable.

Signature: ________________________________

(Parent or guardian signature for participants under 18)

Date: _______________