The Terminator Entry Form - 22 February 2009

A 10 ish Mile Multi-Terrain Race, starts at 10.30am and finishes at Pewsey School Wiltshire. Please complete in block capitals. Or apply online at: http://www.runnersworld.co.uk/events/

Surname (Family name):    

Forname(s):

Address:   

Postcode:                 Telephone:

Team Name: 

UKA Affiliated Club:  The England Athletics Reg. No.

Age on Race Day (min 17yrs):               Date of Birth: Day  Month Year

Male/Female:         E-mail:               

T-Shirt size required:   S()    M()     L()     XL()  

Entry Fee: £12 UKA Affiliated     £14 Unattached   (£2 extra on day)
Cheques made payable to Pewsey Vale Running Club

I declare that I will abide by the UKA rulesrules and the directions of the organizer's representatives. . 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. I understand that the organizers reserve the right to delay or cancel the event should adverse weather conditions or other circumstances outside of the organizers control pose an unacceptable risk to the participants. On the date of the event I will be 17 years of age or older

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, entries after 7/2/2009 to be collected on the day.