Form

Run under UKA regulations - Permit No: 2013 105385

Entry Fees: £12 per person or £1 0 per person if attached to an Athletic Club

Payment by Credit or Debit Card required with this booking form

Full Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
Town	County
Post Code	Country

Phone Number*

- Area Code Phone Number

E-mail*

Age on Day of Race*

Please indicate*

Male Female

Race T Shirt Size*

Are you attached to an Athletic Club?*

Yes No

If yes, please give name of club

Membership No

Would you like to add additional entrants who live at the same address?*

Yes No

Person 2*

First Name Last Name

Age on Day of Race*

Please indicate*

Male Female

Race T Shirt Size*

Are you attached to an Athletic Club?*

Yes No

If yes, please give name of club

Membership No

Would you like to add additional entrants who live at the same address?*

Yes No

Person 3*

First Name Last Name

Age on Day of Race*

Please indicate*

Male Female

Race T Shirt Size*

Are you attached to an Athletic Club?*

Yes No

If yes, please give name of club

Membership No

Would you like to add additional entrants who live at the same address?*

Yes No

Person 4*

First Name Last Name

Age on Day of Race*

Please indicate*

Male Female

Race T Shirt Size*

Are you attached to an Athletic Club?*

Yes No

If yes, please give name of club

Membership No

PAYMENT DETAILS:

You will be transferred to PayPal to complete you payment when you submit this form.
(PayPal account not necessary - simply sign in as a guest)

Please indicate number of entries*

10 Mile Entry (Not attached to a club) £12.00 GBP

Quantity
10 Mile Entry (Attached to a Club) £10.00 GBP

Quantity

Total: £0.00 GBP

Please confirm that entrants under 18 have parent/guardian consent to enter race

Tick to confirm

Click here to confirm you agree to abide by the rules & regulations of this event*

I Agree

Enter the message as it's shown*

RULES & REGULATIONS

1 – The maximum number of entries for this event is 250

2 - No entries will be accepted on the day of the race

3 – Race numbers and show information will be mailed out approximately 2 weeks prior to the event

4 – The Heckington Show website ( www.heckingtonshow.org.uk ) will provide any additional information or allow you to submit any queries. Information on Sleaford Striders can be found on www.sleafordstriders.org

5 – By submitting this entry you declare that you are medically fit to take part in this event and are entering at your own risk – you accept that the organisers or any other party connected with the event will in no way be held responsible for any injury or illness incurred before, during or as a result of the event or for any property loss in any area connected with this event

6 – The minimum age for entry is 17

7 – Closing date for all entries is 6th July 2013

8 - The wearing of ear phones for use with iphones, ipods, MP3 players, etc is strictly forbidden

10 Mile Road Race Online Booking Form 2013

Thank You