www.runningdiary.co.uk ...to find your next race	Universal Entry Form 21st HILLY CLOTHING COMPANY ANNUAL TOUR OF THE DERWENT VALLEY : STAGE 4 Monday 31st May 2010
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) 4 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 tough 4 mile road race.

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