L Street Running Club 
2008 MEMBERSHIP APPLICATION

Check here if you wish to print of the newsletter from the website rather
than receiving it in the mail  [   ]

Membership Plan - Please check one: 

individual membership $45  [   ]                              Family   membership    $50  [   ]
   

Please Print all Entries Clearly
Last Name:______________________________________ First
Name__________________________
  Male   [   ]        Female  [   ]                    Additional Contribution to the LSRC Charity Fund   $                      
        
                          List First Name of any Family Members (Spouse and Children 18 years old or younger)
                             to be included in the Family Plan
    Name                                                           Age   

  _______________________________             ______		  Name                                                             Age   
  
 _______________________________              ______ 

  ___________________________             _____
___________________________               _____   
  Your Contact Information

 Street:  _________________________________________________
 Apt #:                        

 City:    ________________________________		   
 State:                      
 Zip:                            

 Home Phone                                                 
 Office Phone:                                                     

 E-mail address  _______________________________________________________________________

Make checks payable to: L STREET RUNNING CLUB   and Please mail to:

                                                                         LSRC
                                                                         c/o Michael Hunt
                                                                        169 Walnut Street    Apt #1
                                                                         Dorchester MA  02122