Fall MSRC 2009 Registration

Fall 2009 Registration Form

Fall 2009 Training Begins:
Saturdays, Sept. 5th @ 7:30 a.m.

Full Name:	Email:
Address:	Date Of Birth:
City:	State:		Zip:
Cell Phone:	Home Phone:
Emergency Contact Person:	Emergency Contact Number:	(other than the phone numbers given above):

Registration Options: (please check)
Veteran Members	New Members
Saturday Only, Metro - $40.00	Saturday Only - $40.00
Stillwater Fall Monday PM - $25.00

Punchcards (Veteran members only)	Discounts for seasonal members only: (Punchcard members do not apply) (please check which apply to you) Maximum of $15 discount with any combination
10 Run Punch card - $45.00	$5.00 off if MDRA member
15 Run Punch card - $60.00 20 Run Punch card - $70.00	$5.00 off if you volunteered at a spring race. (please make note of which race)
	$5.00 off per referral (please type in the names of the referrals)

Total Membership Cost

(please add up and type price in the box)

Please submit this form to Coach Kim by pressing the Submit button below. Please make checks payable to Moving Soles and mail them to: Kim Maxwell, 516 2nd St. South, Stillwater, MN 55082.

Moving Soles LLC ACE Certified • ACSM Certified • Member of RRCA 516 2nd Street South • Stillwater, MN 55082 T 651.329.8155 • E info@maxwellfitness.com

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