Please mail this completed form and mail it with your dues:

Membership Order Form
Name:
 Birthdate:
  (Mo/Day/Year)
Address:

(City, State, Zip):
Tel./Home (Please include area code):
  
Tel./Work (Please include area code):
  
Name of 2nd Adult*
 Birthdate:
  (Mo/Day/Year)
Phone (Please include area code):
  
How did you find out about Easy Striders?

 
Are you CPR qualified? (Check one): yes no
Any medical conditions? (Check one): yes no

(If yes please explain:)
The Easy Strider Walking Club is a non-profit organization dedicated to the promotion of walking as a recreational and competitive sport for the fitness and health of both Club members, and the community at large. As a participant in Club sponsored events I understand that I am expected to supply my own medical accident insurance. Excellent coverage is available at nominal cost through membership in USATF (USA Track & Field), the national governing body for track and field, including racewalking. USATF memberships are available from the club. Contact coach Jim.

I understand that I will be undergoing physical exertion while participating in racewalking activities and there are remote possibilities of injury and other complications associated with exercise. In exchange for my application to participate in Club walking activities, I agree to waive and release all claims and causes of action for injury, loss or damage which I may suffer as a result of participating in Easy Striders Walking Club practice sessions and sponsored events. I also agree to hold harmless the members, officers, and coaches of the Easy Striders Walking Club for all such injuries, losses or damages.

I hereby grant permission for first aid to be administered to me in the event of illness or injury until professional medical service arrives.

Signature/Date:

 
Dues: INDIVIDUAL COUPLE
Join Dec 1
thru May 31		 $25.00 $35.00 Free dues for children living at home: T-shirts $6.50
Join Jun 1
thru Nov 30		 $20.00 $30.00


NOTE: Membership dues are subject to change. To confirm dues or renewal fee, please email:

All new memberships include t-shirt for each adult plus a monthly newsletter.
All memberships expire on Jan. 31, by which time renewals are due.
Membership (Check one): Individual Couple*

T-shirt (men's sizes; Check one):
S M L

*Must reside at same address for couple membership.