www.runningdiary.co.uk ...to find your next race	Universal Entry Form Chernobyl 10K Sunday 24th January 2010
Surname:	Postal Address:
Firstname:
Date of Birth:
Age on Race Day:
Gender:MaleFemale	Postcode:
Affiliated Club Name:	Telephone:
Registration Number:	Fax:
Entry Selection: (tick as appropriate) 10Km road race	Email Address:

Age Limits Competitors must be aged at least: 18 years for a marathon 17 years for a half marathon 16 years for a 10 mile race

Declaration A signed entry form will be considered as an acceptance of governing body rules and a declaration that you compete entirely at your own risk.

Signed:

Date:

Entry Instructions Provided by Organiser: Postal -36 Brook Place Preston PR2 1TE Cheques made payable to M&C Ribble Valley Group

Entry Fee: £8.00 pre booked £10.00 on the day

Notes: popular event fully subscribed for the past two years

For Official Use Only

Remember to enclose a large SAE. Please do NOT make cheques payable to Running Diary. Either follow the organiser's instructions provided in the "Entry Instructions" section above, or alternatively leave the payee blank for the organiser to complete. Please add any further information which may be of use to the event organiser on the back of this sheet.

Data Protection: If you do not wish any details to be passed on to a third party, including other running related organisations such as the race photographer, tick this box