LRRC Membership Application/Renewal

Dues are $20 for one year, $36 for two years, or $45 for three years;
dues include all members of a family who live in the same residence.


Check one:   New_______              Renewal______              Address Change_______   


Years Paying For: One_____             Two_____              Three_____


Runner:_____              Walker:______             Date this form was submitted:

Name:

Address:

City, State, Zip:

Phone:                                                Email:

Age:                          Date of Birth:

Spouse:

Age:                          Date of Birth:

Children: __________________________________________
                 __________________________________________


Name of LRRC Member Sponsor (if applicable):

Send entry form & check to:
Little Rock Roadrunners Club
P. O. Box 250229
Hillcrest Station
Little Rock, AR 72225