www.runningdiary.co.uk ...to find your next race	Universal Entry Form Wakefield Hospice City 10k Road Race Sunday 5th April 2009
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    1Km fun run    3Km 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: online at www.sportsystems.net/wakefield or send completed applications to Wakefield Hospice, Aberford Road, Wakefield WF1 4TS. Cheques made payable to Wakefield Hospice

Entry Fee: £11 UKA Club Member / £13 unaffiliated (£2 surcharge for Entry on the day)

Notes: 10k course suitable for wheelchairs. New route to be confirmed for 2009 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