Running Medicine Registration Form: Spring 2017
This season is FREE and will be funded on the loving community we have worked to create in the last 15 months!
* You can earn a sweet RM water bottle by registering and attending 10+ practices.
* If you want to buy an RM shirt, we will have those available in multiple colors/styles for $15 each


First and Last Name
Your answer
Age
Your answer
What group will you be participating with?
Tribe(s) / Ethnicity
Your answer
Phone
Your answer
Is this a cell phone that can receive texts?
Email
Your answer
How many seasons have you run/walked with RM?
What 1-2 goals do you have for your summer season with RM?
Your answer
Primary Contact Info (First and last name, relationship to athlete, phone number, and email)
Your answer
Secondary Contact Info (First and last name, relationship to athlete, phone number, and email)
Your answer
Do you have any medical conditions? If YES, please tell us the medications you currently take.
Your answer
Please read and sign the waiver
Please read and sign the waiver
Today's date
MM
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DD
/
YYYY
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