Membership Registration Form

In addition to this form you must pay your allotted fee by Venmo (Richmond-Rockets or by mail application and check addressed to Richmond Rockets and mailed to Nancy Wagner-Wetzel at 81 Alan Loop, Staten Island NY, 10301

Date

Month

Day

Year

First name

Last name

Gender Identity

Multi-line address

Country/Region

Address

City

Zip / Postal code

Birthday

Month

Day

Year

Shirt Size

Membership Type

Please include your spouse's name if you are registering for family membership (You will pay together but must fill the form out seperately)

Please include your child's name if you are registering them as part of your family membership (they must fill the form out separately)

Please give a brief description of yourself (running goals, personal accomplishments, favorite race, distance, etc)

Do you confirm that you have paid the required membership fee?

Yes! I have venmoed richmond-rockets

Yes! I have sent my check for Richmond Rockets to Nancy Wagner-Wetzel at 81 Alan Loop, SI NY, 10301

I am registered as a family member and paid with my spouse!

Signature

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