PUMPKIN 10KM (INCLUDING A 5KM) 25 SEP 10

 ENTRY FORM

First Name.........................................................Surname....................................................

DOB (Day Month Year)......................................Age on Race Day......................................

Sex:     MALE            FEMALE

E-Mail Address:.............................................................(For confirmation of entry)

ENTRY FEE

10km           £10 + £2 EXTRA ON THE DAY

5km             £8 + £2 EXTRA ON THE DAY

I enclose a cheque to the cost of £......................

(Please make cheques payable to Berwick St James Parish Meeting)

So that we can maintain an accurate count of the actual numbers running

All race numbers are to be collected on the day (pins will be available).

I declare that I am an amateur as defined by England Athletics laws.  I certify that I am medically fit to run and the organisers will not be held responsible for any injury or loss to my person as a result of the event, or for any property lost or damaged in the vicinity of the course the car park or the changing area. I understand that the entry fee is not refundable or transferable.

Signed: …………………………………. Date: ……………………….

Closing Date for Postal Entries Friday 24th September 2010

For more information, see www.berwickstjames.org.uk

Entries to: Lou Whiting, Lodge Cottage, Berwick St James, Salisbury, Wiltshire SP3 4TS

email:fwgwhiting@hotmail.com

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FEE PAID                               No. ISSUED                                 CLASS