Membership Type: Single Membership $15.00 Family Membership $25.00               Spouce,Clild1,Child2,Etc. for family membership :

    Name: 

Address:

City: Prov/State: Postal/Zip:

Date of Birth: Age: Gender: Male Female T-shirt size: Small Medium Large Extra-Large

Home Phone: Work Phone:  Email:

Tell us about yourself

How long have you been running:

How many you run:5K:   10K:    15K:     20K:      Marathon:

What is your best:  5K:   10K:    15K:     20K:      Marathon:

What would you like other members to know about you:                 

make cheque payable to
Regina Road Runners Club for the amount of $15.00 and mail to
118 University Park Drive
Regina, Saskatchewan
S4V 0E4