AUTUMN RACE PACKAGE 2025 ENTRY FORM

You have 20 minutes in which to complete and submit the entry form before it times out.
First Name*
Last Name*
Email Address*

Confirmation Email
Birth Date*

DayMonthYear
You must be aged 15 or above to take part in the Wilne 10k and 17 or above to take part in the Derby 10 Mile. Participants under the age of 18 will require parental/guardian permission to participate.
Has your Parent / Guardian given their consent for you to take part in the race?*
Name of Parent / Guardian*
Your Sex*
Address*
Address 2
Address 3
Town/City*
County*
Post Code*
Country*
Please note that the option to post your race number is only available if you live in the United Kingdom. As an international runner, your race number will be made available for collection on the morning of the race.
Phone Number*
Which race entry package would you like to purchase?*
Predicted Time for the Wilne 10k*
Please enter time in minutes. Your estimated time will be used to allocate your starting pen. If you are unsure, please enter "70".
Predicted Time for the Derby 10 Mile*
Please enter time in minutes. Your estimated time will be used to allocate your starting pen. If you are unsure, please enter "120".
T-Shirt Size (S/M/L/XL)*
Would you like to have your race packs posted out to you for a discounted rate per race entry or collect them on race morning at no extra cost?*
Race numbers will be posted out separately for both events and will arrive in the week prior to race day.
Postal Costs
Are you affiliated with a club?*
Affiliation Costs
UK Athletics membership number*
Please check that your licence is valid at https://myathletics.englandathletics.org/licencecheck/. Licence checks are regularly carried out and you will be contacted if your licence is not valid. Race packs will not be released without the full payment having been received.
Running Club*
Do you have any medical conditions or are taking any medication that we need to be aware of?*
Please specify your medical conditions and / or medication. *
Next of Kin Name *
Next of Kin Contact Number*
Do you wish to raise money for our official charities, TBC (Wilne 10k) and TBC (Derby 10 Mile)? By choosing this option you agree to be contacted about raising funds through your participation in this event.*
Would you like to add an optional donation to our official charities, TBC (Wilne 10k) and TBC (Derby 10 Mile)?*
The donated amount will be split equally between the charities.
Charity Donation
If you are a UK tax payer, you have the option to claim an additional 25% Gift Aid on top of your donation at no extra cost to you. Would you like to add Gift Aid to your donation?*
To use Gift Aid, you must have paid enough income tax or capital gains tax to HMRC in the tax year in which you make your donation – at least equal to the amount that the charity will reclaim.
Gift Aid 25% calculation
Are you entering the Midland Masters Athletic Club 10k Championships?
Midland Masters Athletic Club Number
Are you entering the Derbyshire Athletics 10k Championships at the Wilne 10k and / or the Derbyshire Athletics 10 Mile Championships at the Derby 10 Mile for an additional cost of £2.00 per race? Eligibility for entering the Derbyshire Athletics Championships requires runners to be affiliated to a running club and to either have been born in the county of Derbyshire or have been resident in the area for at least 9 months or based in the area as a member of H. M. Forces before the date of the Championships.*
DAC Cost
Derbyshire Athletics Qualification*
Are you entering the Midland Counties Athletics Association Road Race 10k Championships? Eligibility for entering the Midland Counties Athletics Association Road Race 10k Championships requires runners to either have been born in the Midlands or have been resident in area for at least 9 months or based in the area as a member of H. M. Forces before the date of the Championships.*
Midland Counties Championships Qualification*
Do you want to receive any future emails from the Wilne 10k and Derby 10 Mile (including breakfast/evening runs, road races and special offers). We aim to send no more than two emails per month and we never pass on your email address to any other company. You can unsubscribe at any time.*
If you have a unique event code provide by the organisers, please tick YES below:

YES
Event Code*
An acceptance message will appear below if your code is valid. Only valid discount codes will be accepted.
Discount Total
Your discount has been applied.
TOTAL PAYABLE
ALL ENTRANTS MUST READ AND AGREE TO THE TERMS AND CONDITIONS OF ENTRY FOR THE WILNE 10K AND DERBY 10 MILE
Please verify that you are human*

Minus discount of £{discountTotal}
By adding Gift Aid, the charity will be able to claim an additional £{giftAid} on top of your donated amount, thank you.
You are purchasing:

Autumn Package 2025 Standard Entry

Club Affiliation (Affiliated £40.50 / Unaffiliated £44.50): (£{areYou53})

Post (+£3.00) or Collect (+£0.00) Race Number: (+ £{postalCosts})

Charity Donation to official charities, TBC (Wilne 10k) and TBC (Derby 10 Mile): (+ £{wouldYou117})

TOTAL COST: £{totalPayable}
Please note your payment balance is £{totalPayable}.

If you would like to use this amount, please click back and add the postage option or a charity donation. Otherwise click Submit.

Please note that the event code can only be used once and any outstanding balance can not be claimed after checkout.

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