Hansons Olympic Development Organization
Membership Order Form

Name:________________________________________

Street Address:_________________________________

City: _____________________  State:___   Zip:_______

Telephone: (____) ____-______

E-Mail (If Available):_____________________________

Membership Fee (Check One):  ___  $25   ->   Basic Membership

                                                      ___  $100 ->   Bronze Sponsor

                                                      ___  $250 ->   Silver Sponsor

                                                      ___  $1000 -> Gold Sponsor

                                                      ___  $____ -> Other

Shirt/ Jacket Size (S, M, L, XL) Please include shirt or jacket size if an Olympic  Level Sponsor. 

Return Completed Application To:
Hansons Running Shops
ATTN: Olympic Development Program
3407 Rochester Rd. 
Royal Oak, MI  48073

All contributions go to support Hansons Olympic Development Program

Make all checks payable to:  Running USA - Michigan

Hansons Running Shop Team USA - Michigan is a program of Running USA INC., A 501(C) 3 Federal Tax exempt nonprofit organization Incorporated in Minnesota.  Its IRS tax identification number US 36-4303950.