| Name: | _____________________________________________________ |
| Address: | _____________________________________________________ |
| City: | _____________________________________________________ |
| State: | ______ Zip:____________ |
| Email: | __________________________________ |
| Phone: | __________________________________ |
| Birthday: _______________ |
| Circle one: Female Male |
Membership entitles you to run in club races for $2.00, and to receive the monthly club newsletter, The Lookout, by mail.
| Mail dues to: | Iroquois Hill Runners |
| P.O. Box 14115 | |
| Louisville KY 40214 |
We are a family oriented club, please list the names and birthdates of other family members who run, would like to help with club activities, or enjoy picnics and other gatherings: