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Valley Stream Running Club 2017 Application

Since 1979, the VSRC has provided the residents of Valley Stream, and its neighboring communities, an opportunity to learn about, participate in and enjoy a leisure activity that benefits the mind as well as the body. No matter what your ability, whether you're a runner, jogger, walker, cyclist or swimmer, fast or slow, novice or veteran, join us to improve your overall fitness, make new friends and have some fun doing it.

Membership Application

Name: ___________________________  M or F (Circle)

Address: ______________________________


Home Phone: _______________________

Cell Phone: ___________________

e-Mail: ________________________________

Personal Training Goals and Interests (Optional): _____________________________________________


Signature: _____________________  Date: _______  Date of Birth: _________

If under the age of 18, the application must be signed by a parent or legal guardian.

2017 Membership Fee Options: (Check One):
[   ]  $25 Individual Membership
[   ]  $20 Senior Membership (Age 65+ as of 1/1/17)
[   ]  $15 Out of State Individual Membership

   [   ]  Add $5 to convert your membership to a Household Membership (One max. Complete two applications.)

Amount Enclosed: $________   Check#: _______ Checks made payable to: The Valley Stream Running Club

I understand that all VSRC activities are intended to promote good health, so I assume responsibility for participating as far as my own physical fitness is concerned, and for any injuries or accidents that might occur as a result. I therefore release and waive any rights or claims for damages which I might otherwise have against the Valley Stream Running Club, as well as other persons or party connected with the Club's activities, their officers, administrators, successors, members or assigns.

------------------------- Cut & mail section above. Keep section below for your records ---------------------------------

For additional questions, please contact us at: valleystreamrunningclub@gmail.com 

VSRC Website: www.vsrunningclub.org/    VSRC e-mail address: valleystreamrunningclub@gmail.com

Mail Application & Check to:       


Welcome! Upon processing your application, you can expect to hear from our Club’s President to learn more about our club and how we can help you reach your personal goals.