www.runningdiary.co.uk ...to find your next race	Universal Entry Form Larwood Healthy Hearts 10k Sunday 11th May 2008
Surname:	Postal Address:
Firstname:
Date of Birth:
Age on Race Day:
Gender:MaleFemale	Postcode:
Affiliated Club:	Telephone:
Registration Number:	Fax:
Entry Selection: (tick as appropriate) 10Km road race    1.5Km fun run	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: Entry form on web page, Cheques made payable to 'Karen Bestwick'

Entry Fee: £6.50Affil, £8.50NonAffil, All plus £2.00 on day

Notes: 3 Counties 10k race. Scenic, interesting, great feed back.

For Official Use Only

Remember to enclose a large SAE. Please do NOT make cheques payable to Running Diary. Instead use either the event name or the information in the 'Entry Instructions', 'Entry Fee' or 'Notes' sections. 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