www.runningdiary.co.uk ...to find your next race	Universal Entry Form The Derwent River Relays (4 x 3.2 miles) Saturday 17th July 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) 4 x 3.2 mile multi terrain (relay)    0.5 mile fun run    1 mile fun run    1.5 mile 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: Contact Steve Winfield to request an entry form via e-mail or print form from club website. Full entry criteria detailed on event entry form. Universal Entry Form- cheques payable to Belper Harriers. Send to 59 Warmwells Lane, Ripley, Derbyshire DE5 8JB

Entry Fee: £16 per team of 4 runners (+ £2 for each unattached runner aged 18 or over). £2 extra per team payable for on-the-day entries.

Notes: Facilities include; Race commentary/ Music PA/ Licenced bar/ Hot & cold snacks/ Penalty Shoot-out attraction. Pre-entries close 14/7/10. Full event details, including directions and course maps etc. will be posted out to all entrants.

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