Membership Application

Last Name________________________First________________________

Spouse__________________________

Street___________________________City_________________Zip______

Phone___________________Email________________________________

Membership Type:  Family $20___ Individual $15___ Youth $5___

USATF Number ($5 Discount if applicable):________________________

Childrens Names if Family________________________________________

Fill out, attach check to: "Pineland Striders" and Mail to:

Pineland Striders

14 Schoolhouse Drive

Medford, NJ  08055