Greater Philadelphia Track Club_(#08-0081)
Membership Form 2008 (1/1/08-12/31/08)
Member of the United States Track and Field Assoc Club
New Member________ Re-New Membership_______
Membership Form 2008 (1/1/08-12/31/08)
Member of the United States Track and Field Assoc Club
New Member________ Re-New Membership_______
Name_____________________________________________ (please print all info) Gender ________
Address_______________________________________________________________
City__________________________________ State____________ Zip________________
Phone____________________________________ E Mail _________________________________________
Age_____________ Birthdate_______________ High School __________________________
College_______________________________ Best times in career in (to be used in bio page)
Events/time you ran from 400- ultra races________________________________________________________
___________________________________________________________goals for 2008_____________(use back of sheet if
needed)
###New members, please send a head shot to me at thomasd611@yahoo.com for biography page
********************************************************************************************************************************************
*****New members fill out this section. Current members fill out if you have had a PR in the past year****
Interests/Background (check off one or more)
1)Cross Country_____ 2)Track ______ Events___________________________________________
3)Road Races ______ 4) Racewalking_______ 5)Off Road (trail)_______
My most recent best times on track or road (in past 3 years) are
400____________ 800____________ mile/1500_____________ 5,000____________ 10,000__________ Mar._________
Cross Country (list race course and time)
Course______________________________ Time________________
********************************************************************************************************************************************
New Members Membership Price is $45 (includes GPTC singlet) List singlet size_________
Download this form, fill it out and Make check payable to Greater Philadelphia Track Club Send to :
Philadelphia Athletic Charities, 611 Jamestown Street , Philadelphia, Pa 19128 New Members, if you do not have a current
USATF Membership, Click on the USATF Logo above for membership form. You will be given option to use credit card or
download application and send it in with check. You must have a current USATF # to compete for our club. GPTC club # 0081.
If you are a transfer from another USATF club, you must notify MA-USATF of desire to change. (90 probation period from last race)
Current Members Wishing to Renew: Price is $25 Fill out top personal info,sign release, and send with payment to Dave
Thomas, 611 Jamestown St Phila Pa 19128 . Renewable members are responsible for keeping their USATF
membership up to date.
All GPTC members will be given a $5 discount on all PAC Produced Races (Schuylkill River Loop, NE Philly 5, Phil
Catholic League XC, Ocean City Police Chase).
I, the undersigned, for myself, heirs, personal reps, and assigns intending to be legally bound, do hereby waive and release all rights,
claims,demands and /or causes of action against the Philadelphia Athletic Charities Track Club or parent company (PAC), and all of it's directors or
reps for personal injury which I may sustain during any club activity or practice, known to me or hereby discovered, and for any and all damages
which I might occur now or in the future arising from or out of my participation in club events. I also release PAC Inc for the use of my image for
any promotional event associated with the club or company.
___________________________________________________________
Signature Date
Address_______________________________________________________________
City__________________________________ State____________ Zip________________
Phone____________________________________ E Mail _________________________________________
Age_____________ Birthdate_______________ High School __________________________
College_______________________________ Best times in career in (to be used in bio page)
Events/time you ran from 400- ultra races________________________________________________________
___________________________________________________________goals for 2008_____________(use back of sheet if
needed)
###New members, please send a head shot to me at thomasd611@yahoo.com for biography page
********************************************************************************************************************************************
*****New members fill out this section. Current members fill out if you have had a PR in the past year****
Interests/Background (check off one or more)
1)Cross Country_____ 2)Track ______ Events___________________________________________
3)Road Races ______ 4) Racewalking_______ 5)Off Road (trail)_______
My most recent best times on track or road (in past 3 years) are
400____________ 800____________ mile/1500_____________ 5,000____________ 10,000__________ Mar._________
Cross Country (list race course and time)
Course______________________________ Time________________
********************************************************************************************************************************************
New Members Membership Price is $45 (includes GPTC singlet) List singlet size_________
Download this form, fill it out and Make check payable to Greater Philadelphia Track Club Send to :
Philadelphia Athletic Charities, 611 Jamestown Street , Philadelphia, Pa 19128 New Members, if you do not have a current
USATF Membership, Click on the USATF Logo above for membership form. You will be given option to use credit card or
download application and send it in with check. You must have a current USATF # to compete for our club. GPTC club # 0081.
If you are a transfer from another USATF club, you must notify MA-USATF of desire to change. (90 probation period from last race)
Current Members Wishing to Renew: Price is $25 Fill out top personal info,sign release, and send with payment to Dave
Thomas, 611 Jamestown St Phila Pa 19128 . Renewable members are responsible for keeping their USATF
membership up to date.
All GPTC members will be given a $5 discount on all PAC Produced Races (Schuylkill River Loop, NE Philly 5, Phil
Catholic League XC, Ocean City Police Chase).
I, the undersigned, for myself, heirs, personal reps, and assigns intending to be legally bound, do hereby waive and release all rights,
claims,demands and /or causes of action against the Philadelphia Athletic Charities Track Club or parent company (PAC), and all of it's directors or
reps for personal injury which I may sustain during any club activity or practice, known to me or hereby discovered, and for any and all damages
which I might occur now or in the future arising from or out of my participation in club events. I also release PAC Inc for the use of my image for
any promotional event associated with the club or company.
___________________________________________________________
Signature Date
