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SURNAME |
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FIRST NAME |
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| ADDRESS |
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AFFILIATED CLUB
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| POSTCODE |
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Age on Race Day |
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MALE/FEMALE | |||||
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| D.O.B. |
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Anticipated Time |
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| Telephone |
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I enclose a cheque/PO for |
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SELF ADDRESSED STAMPED ENVELOPES NOT NEEDED (Race packs will be sent a few weeks before the race) To receive your race results, please address an envelope which will be available on the day from the information desk |
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I declare that I am an amateur as defined by SEAA rules, I will abide by the rules for competition issued by SEAA. I will be 17 years or older on the day of the event. I declare that I will not participate unless I am fit to run the event for which I have entered. I agree that the organisers will in no way be held responsible for any injury, loss or illness, as a consequence of my participation in these events, or any loss or damage to my belongings. |
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Signed............................................................. |
Date............................... |
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