www.lanierrunningclub.org

LANIER RUNNING CLUB

MEMBERSHIP/RENEWAL APPLICATION

The membership year is from January 1, 2013 to December 31, 2013. Dues are prorated to 50% after July 1, 2011. If you join between November 1 and December 31 the membership will be valid for the following year as well.

MEMBERSHIP TYPE: Individual ($20.00)     Family ($30.00)     Student ($10.00)

Please make checks payable to “Lanier Running Club”.

AMOUNT ENCLOSED:_______________________________

MEMBER NAME: ________________________________  DOB:________________

SPOUSE NAME:__________________________________  DOB:________________

CHILDREN’S NAME AND DOB:___________________________________________

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ADDRESS______________________________________________________________

CITY____________________________  STATE________________  ZIP___________

HOME PHONE___________________  WORK PHONE_____________________

CELL PHONE____________________  E-MAIL___________________________  

Please fill out the Membership Application form and return it with the appropriate amount to:

                        Lanier Running Club

                        P. O. Box 13

                        Gainesville, GA  30503

Please fill in all of the information on the form so that we can develop an up to date membership roster.