Official Old Fart Running Form

please print off this form and mail with your $5.00 check or money order

payable to : Old Farts Running Club, 913 Covell Ave. N.W., Grand Rapids, MI, 49504

NEW____   RENEWAL_____ Old Card #______ if known

Print Name:____________________________________________

Address:______________________________________________

City:________________State:__________Zip:___________

Age:_______ Gender:________ Date of Birth:_______________

Email Address:_______________________________

Once we receive your payment you will be sent an official

Old Fart Running Club membership card...remember being an Old Fart has its priviledges!!!

 Your card will save you $5.00 off all Old Fart races!