NEW RENEWAL
NAME
ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
E-MAIL ADDRESS
SEX: FEMALE MALE
BIRTHDATE
FAMILY MEMBERSHIPS: (indicate names, birthdates, sex)
MEMBERSHIP (Check One):
REMIT CHECKS PAYABLE TO: HARRISBURG AREA ROAD RUNNERS CLUB C/O Walt Greene 431 Spring House Road Camp Hill, PA 17011
MEMBERSHIPS EXPIRE AT THE END OF THE MONTH IN WHICH YOU JOINED, PLUS 30 DAYS GRACE. RESTRICTED DATA SHOULD BE SO INDICATED
PRINT AND MAIL COMPLETED APPLICATION FORM TO:
HARRISBURG AREA ROAD RUNNERS CLUB C/O Walt Greene 431 Spring House Road Camp Hill, PA 17011 (BACK TO HARRC HOMEPAGE)
APPLICATION