Track 'n' Trail     -    Thursday 20th Aug 2009, 7.30pm

Entry Form

Surname:    

Forename(s):

Address:   

Postcode:                 Telephone:

Club Name:

Age on Race Day (min 15yrs):                Date of Birth:

Male/Female:         E-mail:

Entry Fee: £5   (£7 Unaffiliated)    (£1 extra on day)
Cheques made payable to Grass Roots

Declaration: I agree to abide by the UKA rules. I am medically fit to run and understand that I enter at my own risk and that the organisers will not be held responsible for any loss, damage, action, claim, injury or illness which may arise as a result of my participation. Minimum age: 15 years on race day. The organisers reserve the right to cancel the event due to unforeseen circumstances and entry fees are non-refundable and non-transferable even in the event of cancellation.

Please send completed form with 9X4 SAE by 15/8/09, plus cheque to Race Organiser:
Stephen Goulding, 2 The Old Dairy, Salthrop Farm, Bassett Down, Wiltshire SN4 9LX (Phone 0753 4997795).

E-mail: gouldings@waitrose.com

Include 9x4 self-addressed stamped envelope.

Signed: ________________________________________________            Date:____________________________