Membership in This Club Is Only Open to Active Or Retired Employees of NYPD, Law Enforcement

2017 MEMBERSHIP (Expires December 31, 2017)

Membership in this club is only open to Active or Retired employees of NYPD, Law Enforcement members from other agencies, and invited guests. If you are a guest of an NYPD employee you must include their name and tax number below. If you are a guest of a member of another Law Enforcement agency you must include their name, rank, agency and contact information. Any application that doesn’t follow the above criteria will be returned.

Last Name First ______

Address ______

City State Zip Code ______

Phone # ___ __ Date of Birth ______Gender ______

E-mail Address _ Entry Fee $20.00 NYPD Member Active __ Retired ____+ Rank _____ Tax # ______Cmd ______

Other Law Enforcement ___ List Rank and Agency ______

Invited Guest (Fill in your sponsor’s information below)

NYPD Employee’s Name ______Rank ______Tax # ______

Command ______Tele # or email address ______

Other Law Enforcement Agency Sponsor (Fill in their contact info below)

Name ______Rank ______Agency ______

Tele # or email address ______

Membership Waiver: I know that running and participating in club races and other related events are potentially hazardous activities. I should not enter and run in club activities unless I am medically able and properly trained. I agree to abide by any decision of a race official relative to my ability to safely compete in any event. I assume all risks associated with running and participating in club activities including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, the conditions of the roads 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, I, for myself and anyone entitled to act on my behalf, waive and release the NYPD Running Club, its Officers and/or Members, the City of New York, the New York City Police Department, and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in these club activities, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver. I know that membership in the NYPD Running Club does not guarantee me entry into the New York City Marathon, or any other race. I am also aware that the NYPD Running Club has no official affiliation with the New York Police Department.

Signature Date

Make Check Payable to NYPD Running Club Send check or money order Payable to NYPD Running Club: 99 East 2nd Street, Suite 55, Mineola, New York 11501

Join on line at www.NYPDRunningClub.COM