NIRCA-Membership Application

General Information

Name of University or College *

Club Name *

Club Website * if none, enter "none" and NIRCA will provide. E-mail

Club E-mail *

Club Logo * provide a link or enter "emailed" and send to

Is the club a recognized student organization by your institution? *

Yes
No

Do you receive funding from your institution? *

Yes
No

if yes, how much do you annually receive on average?

Is your club interested in organizing and hosting an event for other NIRCA clubs? *

Yes
No

if yes, when?

Contact Information

Only e-mail addresses will be available to other clubs. All other contact information will be kept private. Any changes in contact information should be sent to immediately.

Club President

Name *

E-mail Address *

Phone Number *

Class Standing *

Additional Officer

Name *

E-mail Address *

Phone Number *

Class Standing *

School Address

Address to which info can be sent while school is in session.

Street Address *

Unit Number

City *

State *

Zip *

Summer Address

Address to which info can be sent while school is not in session.

Street Address *

Unit Number

City *

State *

Zip *

Department Contact Information

eg. club sports, campus rec, student activities

Affiliated Department *

Director's Name *

Phone Number *

There is no fee required to submit this application.

Application review typically takes one week. Upon approval NO FEES are due until one year after initial membership. After 1 year, a one-time, $50 instatement fee is required, along with annual dues. Dues must be paid within 30 days of invoice receipt. Membership is pending until received.

Membership Waiver

I acknowledge that it is my responsibility to understand the risks of competition and to determine whether I am, as well as my fellow club members, fit to safely compete in any NIRCA sanctioned events and will exercise any precautions that may be necessary to avoid injury. If injury does occur during competition, the race organizers, hosts, and sponsors will not be held liable. I also agree that my school's organization will comply with all competition and non-discrimination guidelines set forth in the NIRCA constitution. By typing my name I accept the terms of this waiver and verify that the information provided in this application is accurate and truthful.

Name *

Position *