STRIDE RUNNING NL MEMBERSHIP APPLICATION FORM Step 1 of 4 25% PERSONAL INFORMATIONName(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) PhoneGender(Required) Date of Birth(Required) MM slash DD slash YYYY Type of Membership(Required) Individual Family Student Family MembershipPlease enter the first and last name of every family member that you wish to add to the membership. Please note that family members must reside in the same household.Family Member #1 First Last Family Member #2 First Last Date of Birth for Family Member 1 MM slash DD slash YYYY Date of Birth for Family Member 2 MM slash DD slash YYYY Family Member #3 First Last Family Member #4 First Last Date of Birth for Family Member 3 MM slash DD slash YYYY Date of Birth for Family Member 4 MM slash DD slash YYYY EMERGENCY CONTACT INFORMATIONName:(Required) First Last Relationship:(Required) Phone Number:(Required) ADDITIONAL INFORMATIONWhat is the longest distance you have run?(Required) When was your last race?(Required) Enter month/year and name of raceWhy do you want to join Stride?(Required)How did you hear about Stride?(Required)Facebook GroupWebsiteFriends, word of mouthOtherPlease click to see available options.If "Other", please specify WAIVER OF LIABILITY AND INDEMNITY AGREEMENTConsent(Required)“Activities/Events” shall include, but is not limited to, all activities, events or services in any way provided, organized, sponsored or authorized by Stride Running NL. “Activity/Event Organizers” includes Stride Running NL and its directors, officers, employees, agents, representatives, sponsors, volunteers and organizers or any one of them. I understand and acknowledge that participating in physical fitness Events is a potentially hazardous Activity. I agree not to participate unless I am medically able and properly prepared. I understand and acknowledge that I should not participate in Activities without my physician’s approval. I acknowledge that I am solely responsible for my own medical wellbeing. I undertake to have available my medication and medical information, as applicable, in the event I require medical attention. I hereby acknowledge and agree that (a) I will abide by any decision of a Stride Running NL official concerning my ability to safely participate; and (b) I will assume any and all risks associated with the Activity/Event; including but not limited to, falls, contact with other persons or objects, the effects of weather, traffic, and course/route conditions. I hereby indemnify and save harmless Stride Running NL from any and all liability arising as a result of my having to receive emergency medical treatment in the event of injury or illness during or arising from an Activity/Event. As a condition of participating in an Activity/Event, I release Stride Running NL and Activity/Event Organizers from, and hereby waive, all present and future claims and liabilities of any kind, known or unknown, arising out of our participation in the Activity/Event even though such claim or liability may arise out of negligence or fault on the part of the Activity/Event Organizers. I hereby acknowledge and agree (a) that the Activity/Event Organizers shall not be liable for any personal injury, death or property loss, and I release the Activity/Event Organizers and waive all claims with respect thereto, and (b) to hold harmless and indemnify the Activity/Event Organizers from any and all liability from any property damage or personal injury to any third party resulting from my participation in the Activity/Event. I grant permission to the Activity/Event Organizers to use or authorize others to use my personal information, any photographs, images or documentation of our participation in any Activity/Event for marketing purposes without remuneration being provided to me. I understand that, if an Activity or Event cannot be held as scheduled, I may not be entitled to a refund of any money paid. I represent and warrant that I am over eighteen (18) years of age. I have read this Waiver of Liability and Indemnity Agreement. I understand and accept its terms.CAPTCHANameThis field is for validation purposes and should be left unchanged.