| Full name: |
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| Full Address: |
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| Postcode: |
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| Are you a member of a UK Athletics Club? If yes please enter club name here: |
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| Age on 11/07/10 (minimum Age 15 on day of race): |
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| Date of Birth: |
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| T-Shirt Sizes: |
| Please choose the size of your T-Shirt |
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| Race Entry Type: |
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| RACE ENTRY FEE: £12.00 |
| Predicted Time to complete event (HRS/MINS): |
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| Please let us know if you have a special reason for running: |
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| Where did you hear about the event? |
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| Note: Would you like to receive updates and race details on this and future running events?
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| In the event of cancellation for reasons beyond our control the entry fee will be donated to charity. Would you prefer to receive a refund?
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I acknowledge that the event sponsors, race directors, or any person involved in the organisation of the event shall not be liable for any injury, accident, loss or damage suffered by me in, or by reason of the event, however such may be caused. I am HEALTHY and have NO KNOWN medical conditions or any other reason why I should not participate in the event. By completing this application form you consent to the collection, storage, processing and use of your personal information in accordance with the Data Protection Act 1998 or any amendment or replacement of the same. I have read, accept and agree to all conditions of entry.
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