Walking Club of Georgia

APPLICATION FOR MEMBERSHIP

Member:	Select the type of membership from the list:		Payment Method
Renew New Rejoin			Credit Card Check (Send by Mail) Generate Follow Up Letter

Member 1:
First Name
Last Name
Date of Birth
Gender	MaleFemale
Street Address
Address (/Apt#)
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
Email Address

Member 2:		Member 3:
First Name		First Name
Last Name		Last Name
Date of Birth		Date of Birth
Gender	MaleFemale	Gender	MaleFemale
Work Phone		Work Phone
Cell Phone		Cell Phone
Email Address		Email Address
Member 4:		Member 5:
First Name		First Name
Last Name		Last Name
Date of Birth		Date of Birth
Gender	MaleFemale	Gender	MaleFemale
Work Phone		Work Phone
Cell Phone		Cell Phone
Email Address		Email Address

Get involved by helping in one or more of the following areas - Select any of the following that apply:
Event Volunteer	Publicity	Membership	Racewalk Judge
Newsletter	Walk Leader	Hiking	Race Organizer

EDUCATIONAL FUND The Club promotes the benefits of walking to people of all ages. Funding for clinics, seminars and other programs is supplemented by contributions from members when they join the club of renew their membership. If you wish to support these programs please add your optional donation to your membership fee and note that amount below.
Fund donation amount:		$

Order Tee-Shirts: Club Tee Shirt $12 ea:	M Quantity L Quantity XL Quantity

Newsletter Elections:
I want my newsletter e-mailed to me. I want my newsletter mailed to me (will arrive up to a week later).

Comments: Use this for additional information or claifications


By submitting this application, I (we) agree to assume all risks associated with participating in any activity of the Walking Club of Georgia, Inc. I (we) release all sponsors, officers and any persons assisting on a volunteer basis from any claims of liability resulting from my (our) participation.