SATURDAY 11^th June 2011   Start time: 2.30p m

Entry Number    to be issued on arrival           ___________ 

Please tick relavent box to indicate which you wish to enter

West Down 10k Run (14years and over) £5 entry fee
West Down 4½k Fun Run (All ages) £3 entry fee

NAME of ENTRANT
AGE  (min 14yrs for10k)
HOME ADDRESS
CONTACT Tel.no

DECLARATION

I declare myself fit to partake in this run.
I am aware of the possiblity of traffic along the route of the run and
will take due care of myself & be respectful of all other road users.
I furthermore confirm that I will be running at my own risk.

 SIGNATURE .............................................................................     DATE..............

If the entrant is under 16 years old: Name of consenting parent/guardian .......................................................... Declaration      (Please tick the  relevant statement) I consent to this entrant partaking in the 4½k Fun Run I cvonfrm that this entrant is over 14 years of age and I consent to him/her partaking in the 19k Run. Signature.........................................................................

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For office use only

Method of Payment              Cheque/Cash                         Amount received £ 


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