Interested in joining the Lake County Milers? You don’t have to be a resident of Lake County to join—we accept runners and walkers from all over the county, state and country. Simply print out this form (or copy and paste the outline below into your own printable document), fill in the blanks and mail it along with your payment to the address shown. It’s that simple.
NEW! Pay your dues online by clicking here.
(Note: A small service charge applies for online registration.)
Lake County Milers Renewal and New Membership Application for Calendar Year—2012
New membership application ___Renewal ___Name and/or address change___
Dues: (Check the one that applies)
____Student membership (junior high through college) $10 annually
____Individual membership $15 annually
____Family membership (2 or more) $25 annually
____Super Senior (ages 70 and up) Free
Mail application and check to:
Lake County Milers, PO Box 490, Middletown, CA 95461 or bring to a Club Run
Info: 707-987-3229 or email jmburnett2@mchsi.com
Note: Your email address helps us to keep you informed!
Name:____________________________________email:________________________
address:________________________________City:________________Zip:________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Name:____________________________________email:________________________
Contact Phone: ___________________________Sex: ____ Birth date: ____________
Club Membership Application Waiver:
I know that running and volunteering to work in club races are potentially hazardous activities. I should not enter and run in club activities unless I am medically able and properly trained. I assume all risks associated with running and volunteering in club activities including, but not limited to, falls, contact with other participants, the effects of the weather, the conditions of the road and traffic on the course, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I, for myself and my dependents, or anyone entitled to act on my behalf, waive and release the Lake County Milers club members, officers, Hidden Valley Lake Association, the County of Lake, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation, or that of my dependents in any club activity, even though that liability may arise out of negligence or carelessness on the part of the persons or groups named in this waiver.
Signature:_____________________________ Date:_____________________
(If you are under 18, this form must be signed by a parent or guardian.)
