Pewsey Mid Week 5 Mile - 5th August 2009 (7:30pm)

Entry Form - Please complete in block capitals / Print, Sign & Send

Surname:      

Forename(s):

Address:       

                      

                      

                      

Postcode:                  Telephone:   

Club Name:

Age on Race Day:            Date of Birth:          England Athletics Membership No.:

Male/Female:                  Email:  

                                                                                  

Entry Fee: £7 Affiliated     £9 Unattached      (£2 extra on day)

Cheques made payable to: Pewsey Vale Running Club       |      Enter online at: www.runnersworld.co.uk

Declaration: I declare that I will abide by the laws and rules of the race. I will follow all instructions given by race officials. I am not under the race minimum age (15) to compete in this event. I accept that the organisers will not be liable for any loss, damage, action, claim, costs or expenses which may arise as a consequence of my participation in this event. I declare that I will not compete in this race unless I am in good health on the day of the race and that in any case I will only compete at my own risk.

Signed: ________________________________________________

Date:____________________________

Please send completed form and cheque to Race Secretary:
Richard Pearce, The Old Orchard, Rudge Lane, Oare, Marlborough, Wilts SN8 4JH (Phone 01672 562412).

Include 9x4 self-addressed stamped envelope by 29/7/09.

Entries after 29th July 2009 to collect Race Number on the day.