Membership Application (please print out and mail in application)
Membership Fee: $20.00

Name: _______________________ Age: ______ DOB: _____________

Address: __________________________________________________

City/State: ________________________________ Zip: _____________

Home Telephone: ________________ Work: (optional) _____________

Fax: (optional) ___________________ Email (optional): ____________

Occupation: (optional): _______________________________________

New York Road Runners Membership Number: ___________________

Signature: ____________________________ Date: ________________

Please send checks payable to:

Hellgate Road Runners, Inc.
14-41 31st Drive
Astoria, New York 11106
Attn: Jared Mestre
(718) 721-7844