Great Bedwyn 10k    -    Sunday 10th June 2007, 10.00am

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: £7   (£9 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 7/06/07, plus cheque to Race Organiser:
Stephen Goulding Willow Barn, Milton Lilbourne, Pewsey, Wiltshire SN9 5LQ (Phone 01672 564876).

E-mail: gouldings@waitrose.com

Include 9x4 self-addressed stamped envelope.

Signed: ________________________________________________            Date:____________________________