SIRC Membership

SIRC Online Registration
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Parent/Guardian Email*
Email Address
Last 4 of SSN (Parent/Guardian)*
How did you hear about us?
Team Member that referred you
You chose "Other" above (please enter how you found us)
PHOTO RELEASE
I hereby grant Southern Indiana Running Club, its representatives, and authorized media, the absolute and irrevocable right and permission to use photographs, video recordings, or any other record of me/my child taken during club events for promotional purposes, including but not limited to use in club publications, social media, websites, and news outlets.

I understand that these materials may be used in various media formats and may be edited or modified for those purposes. I waive any right to inspect or approve the finished product wherein my likeness appears.

I understand that I will not receive compensation for the use of such images or recordings and that all rights to these materials belong to Southern Indiana Running Club.
PHOTO RELEASE*

I Agree to the above photo releaseI do NOT agree to the use of myself or my child's image
Fundraising Participation*

We will participate in the team fundraiserWe choose NOT to participate and agree to pay an additional $250 per runner
# of Runners*
Total Amount JUNK

My Products*

Runner Registration $100 +5% processing fee$105.00

This is the $100 team dues per runner

Quantity

Fundraising Opt-Out Fee per runner$250.00

This is the charge for NOT participating in team fundraisers. This is a per runner fee

Quantity

Total $0.00

Runner 1
Runner 1*

First NameLast Name
Shirt Size*
Birth Date*

MonthDayYear
Birth Certificate

Browse Files
Click the Choose File button to take a picture or upload a file. If you have issues, simply make a copy and bring it to practice. Cancelof
Gender at birth
Runner 2
Name of Runner 2*

First NameLast Name
Shirt Size*
Birth Date*

MonthDayYear
Birth Certificate

Browse Files
Click the Choose File button, to take a picture or upload a file. If you have issues, simply make a copy and bring it to practice. Cancelof
Runner 3
Name of Runner 3*

First NameLast Name
Shirt Size*
Birth Date*

MonthDayYear
Birth Certificate

Browse Files
Click the Choose File button, to take a picture or upload a file. If you have issues, simply make a copy and bring it to practice. Cancelof
Runner 4
Name of Runner 4*

First NameLast Name
Shirt Size*
Birth Date*

MonthDayYear
Birth Certificate

Browse Files
Click the Choose File button, to take a picture or upload a file. If you have issues, simply make a copy and bring it to practice. Cancelof
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SIRC Online Registration