Track 'n' Trail     -    Wednesday 23rd July 2008, 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

I declare that I will 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.

Please send completed form with 9X4 SAE by 19/7/08, plus cheque to Race Organiser:
Stephen Goulding, 2 The Old Dairy, Salthrop Farm, Bassett Down, Wiltshire SN4 9lx (Phone 01793 814398).

E-mail: gouldings@waitrose.com

Include 9x4 self-addressed stamped envelope.

Signed: ________________________________________________            Date:____________________________