www.runningdiary.co.uk
...to find your next race		Universal Entry Form

20th HILLY CLOTHING COMPANY ANNUAL TOUR OF THE DERWENT VALLEY : STAGE 3
Sunday 24th May 2009
Surname:Postal Address:
Firstname: 
Date of Birth: 
Age on Race Day: 
Gender:MaleFemalePostcode:
Affiliated Club:Telephone:
Registration Number:Fax:
Entry Selection: (tick as appropriate)
5 mile 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: Entry form on website & send with cheque payable to D R Denton to : David R Denton, 5 Swinney Lane, Belper, Derbyshire DE56 1EF
Entry Fee: £4 in advance or £5 on the day + £2 unaffiliated: £15 for the Tour in advanceor £17 on the day
Notes: A one lap hilly 5 mile road race

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