Universal Entry Form

Surname:.....................................................First Name:.......................................................

Postal Address.......................................................................................................................

................................................................................................................................................

Town:...........................................................County...............................................................

Post Code:...................................................

Telephone Day..................................................Home..........................................................

Date of Birth:.............................................. Age on Race Day .............................................

First Claim Club.....................................................................................................................

Is The Club Affiliated Y/N.......................... Your Reg No. ........................

Please enter me in:-..........................................................................................Race/Series

Race Date:.....................................................Entry Fee.......................................................

( Cheques to be made payable to: " check race details")

Best time for distance:............................Where Achieved...................................................

I declare that I will abide by the laws and rules of UK ATHLETICS and I accept that the organisers will not be liable for any loss, damage, action, claim, costs or expenses which may arise in consequence of my participation in this event.  I declare that I will not compete in this race unless I am in good health on the day of the race and that, in any event, I will only compete at my own risk.

Signed...........................................................Date.................................................................

Please return this form to the appropriate race organiser together with your entry fee and a  9"x 6" S.A.E. for your Race No and any relevant information

Downloaded from www.plumsteadrunners.co.uk