2016-2017 Membership Application and Renewal

Potomac Valley Track Club

2016-2017 Membership Application and Renewal

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A club for all ages, all paces, all ways

For long distance runners, race walkers, youth, open, masters, and senior track & field athletes

2009 and 2018 Host of USA Masters Track & Field Indoor Track & Field Championships

2013 and 2015 National Champions -- USA Masters Indoor Track & Field Championships

First name______Middle ______Last ______

Address______Apt ______

City______State __ __Zip ______-______

Phone Home______-______-______Work ______-______-______Cell ______-______-______

Email ______Fax ______-______-______

Date of birth (mm/dd/yyyy) __ __/__ __/______Gender (M/F) [__]

Occupation______Special skills ______

[__] Check here if you do not want your name included in publications or on the PVTC web page.

Activities: [__]LDR [__]T&F [__]Race Walk [__]Team competition [__]Other(specify) ______

FAMILY MEMBERS (for more family members, please submit 2 forms, include your name on each, show total fee on first form)

1.Name: First ______Middle ____Last ______

DOB (mm/dd/yyyyy) __ __/__ __/______M/F) [__]Relationship ______Activity ______

2.Name: First ______Middle ____Last ______

DOB (mm/dd/yyyyy) __ __/__ __/______M/F) [__]Relationship ______Activity ______

3.Name: First ______Middle ____Last ______

DOB (mm/dd/yyyyy) __ __/__ __/______M/F) [__]Relationship ______Activity ______

Dues are $20 per year plus $5 per additional member 18 or older, $3 if under 18, maximum of $30 per address.

TOTAL MEMBERSHIP DUES PAID WITH THIS APPLICATION $ ______

Renewals are due January 1. New memberships after September 1 include the next calendar year.

Thank you for joining or renewing with PVTC and for your help with our programs.

WORKER COMMITMENT: Please indicate below the areas where you can assist the Club.

__ Assistant Official__ Marshal__ Scoring__ Food Preparation

__ Certified Official__ Newsletter__ Social Activities__ Education

__ Coaching__ Race Director__ Telephoning__ Registration

__ Water Station__ Other ______

I commit to working these events:

__ By George __ Easter Classic__ Go-Fourth __ Cranberry Crawl__ Christmas Caper

__ TJ Indoor Meets__ All-Comers Meets__ PV Games __ Throws meets__ Multi-event (decathlon/pent)

__ 1 Hour RW/5Krun/Throws__ Race Walk Clinics__ Trail Run/X-country

__ Youth Coaching/Volunteer__ Help Officiate at Youth Meets __ Volunteer

Consider me for these committees:

__ Equipment__ Newsletter__ Social Activities__ Youth

__ Long Distance Running__ Publicity__ Track & Field

__ Membership & Telephoning__ Race Walking__ Uniforms

Comments about your volunteer support: ______

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