www.runningdiary.co.uk ...to find your next race	Universal Entry Form DERBY MIDWEEK TRAINING RACES Wednesday 15th 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) 1 mile road race    5Km 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: Enter ONLY on the night

Entry Fee: £3 to include free results (£1.50 under 16)

Notes:

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