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Berryhill
Fields 10k
&
Junior 2k Event
Tuesday 7th July 2009
Sponsored by Bourne Sports
and ADIDAS
Official Entry Form (please
print out and send in post)
All cheques should be made payable to City
of Stoke AC.
Entries and enquiries to Berryhill Fields 10k, Bourne Sports,
36-42 Church Street, Stoke-on-Trent ST4 1DJ. Tel 01782 410411
Please enclose a SAE to receive race number, map of course and
information
Entry Fees:
Open 10k: £5.00 affiliated, £7.00 unattached
Junior 2k: £2.00
| Surname: |
First
Names: |
Sex: |
Date
of Birth: |
Age
on Race Day: |
Address: |
|
|
Postcode: |
|
Tel
No: |
Club: |
|
NSRRA
No: |
Please enter me in the following event: (Please tick)
( ) Open 10k - minimum age 15 years on Race Day
( ) Junior 2k
Total Entry fees: £
Declaration: Please enter me in the above events for which I
enclose the appropriate fee. I agree to abide by UKA rules and I
understand that the organisers will not be responsible for any
loss or injury however occasional resulting from the event.
Signature:
Date:
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