Membership Application

Make Checks Payable To:	Mystic Runners
Mail Entry To:	Mystic Runners PO Box 1536 Wakefield, MA 01880
Enter Online using a credit card:

         Name: 

      Address: 

         City: 

        State:    Zip: 

Daytime Phone:  Date of Birth:  Age on race date: 

         Gender: M F   

    MEMBERSHIP TYPE 

    New Members please check one (optional club singlet $23)
    Single Membership ($25/year)  Family Membership ($30/Year)

    Renewing Members please check one
    Single Renewal (25)   Family Renewal ($30)

    Singlet size (option for $23) S M L X

 Email Address: 

Waiver Must Be Read and Signed Before Mailing:
In case of injury while traveling or competing, I waive all rights and claims for damages against the Mystic Runners and its members.

_________________________________ _________
Signature and Date
(Parent's Signature if under 18)

OPTIONAL RUNNING HISTORY

This is a running survey that will be given to the Mystic Runners coach so that he may be better able to help you in developing a comprehensive running plan which would be suited to your needs and running goals.

         Name: 

      Address: 

        Phone: 

  1. Have you ever run for an organization or school?  Yes  No
  2. How long have you been running? 
  3. What is your weekly mileage? 
  4. How many races a year do you run? 
  5. What are you best times for these distances? 
    5K  5M  10K  
     1/2 Marathon  Marathon 
  6. Have you ever done speedwork on or off the track? Yes  No
  7. What are your present goals?