or alternatively print screen below
ENTRY FORM
THE DERWENT RIVER RELAYS (& FUN RUNS) 2010
Please complete using BLOCK CAPITALS
Club or organisation name: ______________________________________________________________________
Or community team name: ______________________________________________________________________
Team Manager or person completing entry: _________________________________________________________
A) Please enter the following numbers of relay teams …
Men __________ Veteran Men __________ Ladies __________ Veteran Ladies __________ Mixed ___________
Note: Lower age limit = 13. No runner shall run more than one leg for a team. Runners may run legs for more than one team. Mixed teams shall not contain more than two men. All runners in veteran teams must be of min. age 40 (men) and 35 (ladies). Teams to be declared and race numbers issued on the day. Runner registration numbers will be required on the day for all affiliated athletes declared.
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Imaginative team names would be welcomed, particularly if you enter multiple teams in a category. (Rather than A, B, C team etc.). Team names can be declared on the day.
B) Please enter the following number of entrants for the Fun Run … (Names to be declared on the day)
Adults__________ Children__________
Total number of teams @ £16 each: £________
Total number of unattached runners @ £2 each: £________
Total number of Fun Run pre-entries @ £2 each: £ ________
I enclose a cheque payable to BELPER HARRIERS for…. £________
Please send to: Steve Winfield (Race Director), 59 Warmwells Lane, Ripley, Derbyshire, DE5 8JB enclosing a SAE (C5 or A5 size) for confirmation, directions and further details/instructions.
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Declaration: On behalf of the above team(s) and individuals, I understand that all competitors run at their own risk. All must be medically fit andwill not hold the organisers responsible for any injury or illness, nor loss or damage to property, before, during or after the event. I declare that I will make all competitors in my club’s or organisation’s team(s) aware of this. I hereby sign on their behalf…
Name: _________________________________________Signature: ______________________________________
Address: ______________________________________________________________________________________
____________________________________________________________ Date: ____________________
Phone: _________________________________ E-mail: _______________________________________________
This form may be photocopied
Official use only:
Date received:_______________________ ChequeNumber: ____________________ Details despatched: _____________