South Buffalo Athletic Club Membership Application
RRCA SBAC
Last Name___________________________________ First Name _____________________________
Spouse _________________________
Address _____________________________________________________________________________________
City _______________________________ State ______________ Zip Code _____________________________
Home Phone ____________________________ Other Phone __________________________________________
E-mail Address __________________________________ Fax _________________________________________
Age _________ Gender ____________
Work Location ________________________________________________________________________________
Position / Title ________________________________________________________________________________
Check one: Dues paid:
Charter member ____________ Individual membership $20.00 (year) _________________
Renewing member _________ Husband & Wife - same address $30.00 (year) __________
New member ______________ Student membership $10.00 (year) ___________________
Total Amount Enclosed ___________________
*A Membership year runs from June 1st to May 31. Please make checks payable to South Buffalo Athletic Club. Mail to:
South Buffalo Athletic Club, P.O. Box 901, West Seneca, NY 14224
I know that running and volunteering in club races are potentially hazardous activities. I should not enter and run in club activities unless I am medically able and properly trained. I agree to abide by any decisions of a racing official relative to my ability to complete the run. I assume all risks associated with running and volunteering to work in club races including, but not limited to falls, contacts with other participants, the effects of the weather including high heat and humidity, the conditions of the road and traffic as all such risks are known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your acceptance of my application for membership, I, for myself, and anyone entitled to act on my behalf, waive and release the Road Runners Club of America, the South Buffalo Athletic Club, and all other sponsors, for their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities even though that liability may arise out of negligence or carelessness on the part of the person named in this waiver.
Signature ______________________________________________ Date ______________________________