LightSpeed Running
Application

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NAME:                                                                                                DATE:                                    

ADDRESS:                                                                                                                                         

CITY/STATE/ZIP:                                                                                                                            

HOME PHONE:                                                          WORK PHONE                                                   

E-MAIL:                                                                                                                                             

DATE OF BIRTH:                                                       GENDER                                                           

OCCUPATION:                                                                                                                                    

please complete the following Section TO Help US Better ADDRESS YOUR NEEDS:

WHEN DID YOU BEGIN RUNNING?                                                                                                  

                                                                                                                                                            

WHEN DID YOU BEGIN RUNNING AS A SPORT OF FOR EXERCISE?                                                

                                                                                                                                                             

WHY WOULD YOU LIKE TO JOIN LSR?                                                                                             

                                                                                                                                                             

                                                                                                                                                             

WHAT ARE YOU RUNNING GOALS?                                                                                                    

                                                                                                                                                             

                                                                                                                                                             

                                                                                                                                                              

DO YOU BELONG TO A USATF-REGISTERED COMPETITIVE ATHLETIC CLUB?                                  

IF SO, WHICH ONE?                                                                                                                             

                                                                                                                                                                                                      

                                                                                                                                                                                                       

HAVE YOU EVER BELONGED TO ANOTHER CLUB?                                                                                

IF YES, WHICH CLUB AND AT WHAT TIME?                                                                                        

ARE YOU A MEMBER OF THE NEW YORK ROAD RUNNERS CLUB?                                                        

DID YOU EVER COMPETE IN HIGH SCHOOL OR COLLEGE?                                                                   

IF YES, WHEN AND WHERE?                                                                                                                  

IN WHICH EVENTS?                                                                                                                              

AT WHAT DISTANCES DO YOU NOW COMPETE?                                                                                 

WHAT ARE YOU BEST PERFORMANCES FOR THOSE EVENTS?

1. EVENT/TIME/WHEN/WHERE:                                                                                            
2. EVENT/TIME/WHEN/WHERE:                                                                                            
3. EVENT/TIME/WHEN/WHERE:                                                                                            

WHAT EVENTS DO YOU HOPE TO DO IN THE NEAR FUTURE?                                                           

WHAT TIMES DO YOU HOPE TO ACHIEVE FOR THOSE EVENTS?                                                      

My signature below confirms my desire to become a member of the Harlem Runners Club.  As a member of the LightSpeed Running, I agree to participate in races only for the LightSpeed Running Club, and to not be affiliated with any other road racing or track team.  I acknowledge that training for and competing in track and field events can be an extreme test of a person’s physical and mental abilities and is potentially hazardous.  I hereby assume all risk associated with my participation in any activities organized by LightSpeed Running and its members.  I certify that I am physically fit and have not been advised against strenuous physical activity by a physician.  I further affirm that I have read this entire application and understand its contents.

 

 

Print Name:                                                                                                                                          

Print Date:                                                                                                                                           

Signature:                                                                                                                                            

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©2005 LSR, Inc.