Hidden Valley Lake Milers
Renewal and New Membership Application for calendar year—2008
___New Membership application ___Renewal ___Name and/or address change
Dues: (Check the one that applies)
____Student Membership (Junior High thru College) $5.00 annually
____Individual membership--$10 annually
____Family membership (2 or more) $15.00 annually
Mail application and check to:
Hidden Valley Lake Milers, PO box 490, Middletown, Ca. 95461 or bring to Club Run
Info: 707-987-3229 or email jmburnett2@mchsi.com
Note-your email address allows us to keep you informed!
Name:____________________________________email:________________________
address:________________________________City:________________Zip:________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Club Membership Application waiver:
I know that running and volunteering to work 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 assume all risks associated with running and volunteering in club activities including, but
not limited to, falls, contact with other participants, the effects of the weather, the conditions of the road and traffic on the course, all such
risks being 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 my dependents, or anyone entitled to act on my behalf, waive and release the Hidden Valley
Lake Milers Club members, officers, Hidden Valley Lake association, the County of Lake, and all sponsors, their representatives and
successors from all claims or liabilities of any kind arising out of my participation, or that of my dependents in any club activity, even though
that liability may arise out of negligence or carelessness on the part of the persons or groups named in this waiver.
Signature:_____________________________ Date:_____________________
If under 18 must be signed by parent or guardian