Southern Indiana Racewalkers Membership Application

 

Name:

Mailing Address Line 1:

Mailing Address Line 2:

City:

State/Provence:

Country: Postal/Zip Code:

Email:

Membership Type

Individual Membership $15 (Local) Family $20 (Local) Individual $10 (Non Local) Family $15.00 (Non Local)

Please send check or MO to:

SIRW
515 E. Jennings St.
Newburgh, IN 47630