Frederick Steeplechasers Running Club

On-Line Membership Application

Membership for calendar year 2010.

Welcome to On-line registration. FSRC is a non-profit organization that supports local running. The mission of the FSRC is to: Promote Running as a Healthful, Challenging, and Enjoyable Activity!

In other words, we are the organization that supports both runners and race directors here in Frederick County. How do we do this?  Three primary ways:

Please fill out the following form so that we can get to know you. After you have completed the form, you will click the "Submit" button. This will send the data to our Membership Chair. After sending the data, you will complete the billing process by clicking the "Add to Cart" button to select the types of membership for you and your household. Your credit card billing will be taken care of by Pay Pal. You do not need to have a Pay Pal account to use this service.

Email address is a required field so the club can contact you with any changes to our race schedule or any other events the club may host. We do not sell or give out emails to any person or entity.

To get started, please indicate the committees below that you would like to serve on to contribute to our running community (check as many as you would like): 

Website          Membership   
Social           Training     
Competition      Race Support 
Newsletter  



     
     First Name *    
     Last Name *   
       Address *           
          City *      
         State *    
           Zip *   
    Home Phone     
    Work Phone             
    E-Mail Addr *   
    Occupation     
    Birth Date  *    MM/DD/YY
  Age (in years)   
        Gender *   Male: Female:

Running goals for next year or events you are training for?  

What benefit(s) are you hoping to receive from the club?    

Waiver and Release: I recognize that participation in activities of the organization may involve certain hazards. I understand that I should not participate unless medically able. I assume the risks associated with involvement in these activities, including but not limited to falls, contact with participants, effects of weather, road and traffic conditions-these risks being known and appreciated by me. Having read the Wavier and Relase and considering the acceptance of my application, I for myself and anyone entitled to act of my behanlf, waive and release the Frederick Steeplechasers Running Club, the Road Runners Club of America, and all sponsors and hosts, their representatives and successors, from any claim or liabilty from my involvement in activities of the organization.

Signature:*     Date of signature:

* Required Fields

Type of Membership

      New Renewal

Membership Options


Individual Membership ($20)

Second Member in Same Household ($15)

Junior Member under 18 years of age ($10)

Family ($40)

Complete the following information when registering more than one member in the same household.

Second/Family Members

First Name:               Last Name:
Phone:         Male: Female: Age: Birth Date:

First Name:               Last Name:
Phone:         Male: Female: Age: Birth Date:

First Name:               Last Name:
Phone:         Male: Female: Age: Birth Date:

First Name:               Last Name:
Phone:         Male: Female: Age: Birth Date: