Brisbane River City Runners

APPLICATION FOR MEMBERSHIP 2009-2010

FIRST NAME

SURNAME

ADDRESS

TELEPHONE (W)

TELEPHONE (H)

MOBILE

EMAIL

FAX (if no email)

PARTNER’S NAME

(ice)

SIGNATURE

DECLARATION: In consideration of the acceptance of my application I do hereby for myself, my executors & assignees, release & forever discharge the club & their members, agents,  & representatives from all claims of damages, demands, actions whatsoever in any manner arising out of my participation in club activities. I attest that I have full knowledge of the risks involved in participating & that I have no physical or mental condition which has the potential to put myself or any other person at risk & that I am physically fit to participate in club training activities. I hereby acknowledge that I have sole responsibility for my personal possessions & equipment during training activities. Safety precautions undertaken by the club & club members are a service to me & are not a guarantee of safety. By training I accept all risks necessary following from my participation that could result in loss of life, partial or permanent injury. Accordingly I hereby indemnify the club & its members from all liability (including liability for their negligence & the negligence of others), loss or damage arising out of my training activities. This release & indemnity continues forever & binds my executors, heirs & personal representatives & assigns. I agree that I have read & fully understand the terms & conditions set out in the document.

Annual membership is $25.00.   Membership is for the financial year.

Training fee $2.00 for Tuesday nights covers drinks and other expenses

Payment can be made to the “River City Runners” account – BSB 114-879 Account 130354552

Then please email us with the details.