Longview Running Club Membership Form

Full Price Dues are Students, Military, Retiree- $10.00/yr

Single-$15.00/yr

Family-$20.00/yr

Dues paid January-June 2012 will be full price

Joining after June will be HALF price

Name/Names:_____________________________________________________________

Address:______________________________________City:____________________

State:_____________Zip:____________Phone:__________________________________

Email:_______________________________________________

Birthdate:________________________

Please complete form and mail payment to:

Longview Running Club

PO Box 150555

Longview, TX  75615