MEMBERSHIP APPLICATION

GOLDEN TRIANGLE RUNNING

&

CYCLING CLUB

A NON-PROFIT ORGANIZATION

BENEFITS:

MONTHLY NEWSLETTER WITH RACE SCHEDULES AND ENTRY FORMS

MONTHLY MEETINGS -INFORMATIVE AND INTERESTING HELD ON THE FIRST TUESDAY OF EACH MONTH

CLUB DISCOUNTS ON RUNNING APPAREL

___ Individual Membership -$15 -January 1 to December 31

___ Individual Membership -$7.50 -After July 1

___ Family Membership - $20 -January 1 to December 31

___ Family Membership -$10 -After July 1

NAME ..................................................................... DATE OF BIRTH..............................

ADDRESS...............................................................................................

CITY/STATE/ZIP ...............................................................................

AGE(as of 1 Jan.)..................... SEX ........................ HOME PHONE...................................

BUSINESS PHONE............................

E-MAIL ......................................................

FOR ADDITIONAL FAMILY MEMBERSHIPS PLEASE GIVE:

NAME..................................................... DOB............................ AGE..........

NAME..................................................... DOB............................ AGE..........

NAME..................................................... DOB............................ AGE..........

NAME..................................................... DOB............................ AGE..........

DATE OF APPLICATION ...........................................

PLEASE MAKE CHECK PAYABLE TO AND MAIL TO:

GOLDEN TRIANGLE RUNNING & CYCLING CLUB

P. 0. BOX 702

COLUMBUS, MS 39703-0702

www.runcyclegtr.org