Download Report

QUEENSLAND MARATHON AND ROAD RUNNERS CLUB INCORPORATED
trading as BRISBANE ROAD RUNNERS CLUB (BRRC) – “The Club”
MEMBERSHIP FORM 2015
New Membership
Renewal
FEES (Membership valid for calendar year or part thereof – January to December
NEW MEMBER
SINGLE (18 years and over) $25*
(under 18 years) $15*
FAMILY (same household) $40 plus $5* for each family member
FAMILY of 2 = $50
Family of 3 = $55
Family of 4 = $60
Family of 5 = $65
*Charge of $5 is for hire and use of each electronic timing chip during period of membership
NOTE: CHIP MUST BE RETURNED TO BRRC WHEN MEMBERSHIP CEASES
RENEWING MEMBER SINGLE (18 years and over) $20
(under 18 years) $10
FAMILY (same household) $40
DETAILS (if a family, include all members applying)
Surname:
First Name:
Gender: Male:
Female:
Previous Membership Number (if known)
D.O.B. (dd/mm/yyyy):
Surname:
First Name:
Gender: Male:
Female:
Previous Membership Number (if known)
D.O.B. (dd/mm/yyyy):
Surname:
First Name:
Gender: Male:
Female:
Previous Membership Number (if known)
D.O.B. (dd/mm/yyyy):
Surname:
First Name:
Gender: Male:
Female:
Previous Membership Number (if known)
D.O.B. (dd/mm/yyyy):
Surname:
First Name:
Gender: Male:
Female:
Previous Membership Number (if known)
D.O.B. (dd/mm/yyyy):
ADDRESS
Unit Number/ House Number /Street Name:
Suburb:
State:
Postal Address: (if not the same as above)
P.O. Box:
Suburb:
Post code:
Post code:
Occupation of Adults:
Phone: Home :
Email address:
CONTACT DETAILS
Work:
Mobile:
Emergency Contact
Name:
Phone Number:
Club Magazine Please tick your preference. I would like to receive it by post:
By email:
14
VOLUNTEER ROSTER DUTY:
Please indicate a date or dates that would suit you to do your volunteer duty:
Date(s) available:
Date(s) unavailable:
Request a particular race day – Date:
I don’t mind what date I’m rostered: (tick box)
PTO: Both pages must be completed and presented with your membership fee
Page 1
QUEENSLAND MARATHON AND ROAD RUNNERS CLUB INCORPORATED
trading as BRISBANE ROAD RUNNERS CLUB (BRRC) – “The Club”
WAIVER
TO BE READ AND SIGNED BY ALL NEW AND RENEWING MEMBERS
I/We (your names) …………………………………………………………………………………………………
Hereby acknowledge that running is a potentially hazardous activity, and that I/we have entered/will enter Club events certifying
that I/we am/are medically able and properly trained. I/We also assume any and all other risks associated with participating in all
Club organized and sanctioned events including but in no way limited to falls and contact with other participants or road users
including but in no way limited to cyclists who I/We acknowledge utilise the same roads and paths during the same times
that Club events take place.
Knowing and acknowledging these risks, and in consideration of your acceptance of my/our entry, I/we hereby for myself/us,
my/our heirs, executors, administrators and anyone else who might claim on my/our behalf in respect of any and all liabilities,
claims, damages, costs or expenses which I/we may have against them arising out of or in any way connected with my/our
participation in Club events, including all injuries that may be suffered by me/us before, during or after the Club event(s):
1. covenant not to sue or make demands, claims or otherwise hold the Club responsible,
2. waive, release and discharge the Club, its president, its committee members, servants, agents, or subcontractors, all
instrumentalities, cities, state or councils where Club events are held, and all sponsors, volunteers and representatives and
successors; and
3. Indemnify the Club, its president, its committee members, its servants, agents, subcontractors and volunteers from any
claim brought against I/us arising from my/our acts, omissions and other forms of participation in Club sanctioned and
organised events.
These releases, discharges, waivers and indemnities extend to all claims of every kind or nature whatsoever, foreseen or
unforeseen, known or unknown.
I am/We are aware that photographs may be taken of me/us during any event and I/we hereby consent to such photographs being
used for Club promotion or publication.
I/We acknowledge that I/we may apply to have my/our residential address and other details withheld from inspection of the
Member Register by other Club members if I/we have concerns for my/our personal safety. I/We acknowledge the Club holds
Public Liability Insurance of $20,000,000.Club Constitution and Bylaws may be viewed in the members' only section of the Club’s
website.
1
Volunteer Roster System
Members are requested to support the Club by participating in the roster system. By making yourself available for roster duty when
nominated you are helping to ensure a safe and enjoyable running event for everyone. You will only be scheduled on once
during the current year and you can nominate a date that is suitable to you.
Your name and the date you have been scheduled to volunteer will be published under “Rosters” on the Club website. In addition,
the names of the volunteers for each event will appear in the Club’s monthly e-newsletter. Approximately 10 days before the event
for which you have been rostered, a reminder email with instructions will be sent to you. The event’s Race Director will give you
every assistance to ensure that your volunteer experience is a positive one.
Declaration
I/We have read and understand the waiver. I/We agree to participate in the Club’s Roster System
'LJLWDORUKDQGZULWWHQ
VLJQDWXUHRIDGXOWSDUWLFLSDQWV'DWH
Signature of Parent/Guardian: IRUSDUWLFLSDQWVXQGHU\HDUV
Date:
Thank you for joining BRRC. Complete form electronically as per website instructions (preferred method), OR present completed
form & fee at registration desk on race day OR mail it with your fee to: Registrar, BRRC, P.O. Box 5959, West End QLD 4101
Brisbane Road Runners Club Membership Form 2015
As at 10/05/2015
Page 2