M E M B E R S H I P   A P P L I C A T I O N

Name: ________________________________________________________________

Address: ______________________________________________________________

City: ___________________________________ State: ______ Zip Code: _________

E-Mail Address: ________________________________________________________

Age: _______       Gender (Circle):    Male   Female       Hat Size (Circle):     67/8*

(Actually they are one size fits all --- just checking to see if you're paying attention)

Signature: _______________________________________ Date: _________________

Membership Fee: $5.00 (Include an extra $5.00 if you want your hat mailed to you.
Otherwise you will have to pick it up at a future Moose Miles Running Club race.

Make check payable to 3C Race Productions and mail to: 3C Race Productions, 160 Amherst Road, Merrimack, NH 03054 or bring it to one of our races.