Membership: ____Individual ($15) ____Family ($20) ____Student ($7.50) MBRC T-Shirts, singlets and sweatshirts with a Club Logo.

Sizes: T-Shirt ____ Sweatshirt: ____ Singlet: ____ Men's ____ Women's ____

T-Shirts and sweatshirts are unisex and are available in S, M, L, XL. Please indicate men's or women's.

In consideration for the acceptance of this application, I hereby waive and release any and all rights or claims for damages, injuries or losses that may be suffered by me or any of my guests before, during or after any event or other activity sponsored by the Mercer-Bucks Running Club. This waiver and release includes but is not limited to all races sponsored by the Club and all activities which take place at or from the Lawrenceville School on Wednesday evenings. This waiver and release shall be binding on each of my heirs, executors and assigns and shall apply to all potential rights or claims against the Mercer-Bucks Running Club, its officers or members, the Lawrenceville School and/or any race official or participant. If an applicant is less than 18 years of age, this waiver must be signed by his or her parent or legal guardian. All family membership applications must be signed by each adult.

Name _____________________________________________________________

Date of Birth __/__/__

Signature ________________________________________________________

Street Address_ ______________________________________________________

City___________________State_________________Zip_______________

Home Phone_____________________Work Phone ____________________________

E-Mail Address______________________________________________

Date of Application __/__/__

Membership fee enclosed ($15-single; $20-family; $7.50-student) _______

T-shirts ($8 each) Singlets ($13 each) Hooded Sweatshirt ($23 each) _________

Total enclosed _____________________

Make check payable to MBRC and mail to: Maureen Sikora, 50 Stonicker Dr. Lawrenceville NJ 08648