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2022 MEMBERSHIP

Proud Member of USATF-LONG ISLAND
Register for USATF-LI and join NHP-M Runners and
we will refund you 1 year of your USATF-LI membership

Visit NewHydeParkRunners.com

Harold Axelrod at 917.750.5992 or bcshja@msn.com

MEMBERSHIP OPTIONS

Registration Options*

Individual NHP-M Membership ($20.00)
Family NHP-M Membership ($25.00)

RUNNER MEMBERSHIP ACCOUNT INFO

NAME*

EMAIL*

CELL*

DATE OF BIRTH*

GENDER*

Male
Female

T-Shirt Size*

Country*

ADDRESS*

City, State and ZIP Code*

Special Interests

Social:*

I would be interested in club social activities.
I would NOT be interested in club social activities.

Helping the Club:*

Public Relations
Artwork
Mailing
Secretarial Work
Computer Programming
writing
Organizing
Other (please specify)

Running Total

$0.00

Transaction Fee $2.75

Total

$2.75

BILLING INFO

Name*

Card Number*

Visa
Mastercard
American Express
Discover

Expiration Date*

Country*

Address*

City, State and ZIP Code*

Email*

Confirm Email*

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