Goddard Running & Orienteering Club Home Page

Goddard Running and Orienteering Club (GROC)

Membership Application & Race Entry Form

Last Name:	Gender: M / F
First Name:	Birthdate:
Mail Code:	Work Phone:

Please check the appropriate category:

a) GSFC civil service employee (includes co-op students on duty & retirees)

b) GSFC contract employee--Company:

c) Dependant of (a) or (b)--that persons' name:

d) Guest (none of the above)

EMail address: :
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I would like to:

Participate in 10K race (free)
Join the club ($7/yr 1 Oct through 30 Sept)
Renew membership ($7/yr 1 Oct through 30 Sept)
Enter 2 mile fun run/walk ($3.00 pre-registration for non-members, $5.00 on race-day, free for members)

I enclose (circle please) $7.00 / $3.00 ($5.00 on race day) with this application.

This race application is for Wednesday 12 Oct 2005 10K Event.
Would you consider a leadership role in GROC? Y / N

WAIVER STATEMENT

I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to complete the run safely. I assume all risks associated with running in this event including but not limited to: falls, contact with other participants, the effects of the weather, including high heat and/or humidity, traffic and the conditions of the road, all such risks being known and appreciated by me. Having read this waiver and knowing these facts and in consideration of your accepting my entry, I for myself and anyone acting on my behalf, waive and release the Goddard Running & Orienteering Club, the Goddard Space Flight Center, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.

Signature Signature-Guardian
(if runner under 18 years of age)

Date Date

Signature	Signature-Guardian (if runner under 18 years of age)
Date	Date