Slay the Dragon 10K - Event Entry

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Entry Form Details: Slay the Dragon 10K, 24/02/2013 - Entrant 1

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First name:

Last name:

Address Line 1:

Address Line 2 (opt):

Address Line 3 (opt):

City/town:

County:

Post code:

Telephone number (day):

Email:

Re-type email:

Date of birth:

Gender:

Expected time for distance (opt):

Are you a member of an affilliated club?

Affiliated club:

UKA Affiliated Registration Number:

(if known)

Team name (opt):

I declare that I am an amateur as defined by U.K. Laws and agree to abide by their laws. I will be medically fit to run on the above date. I understand that the organisers of the event will not be held liable for any injury, illness or loss of property, however caused.

Any additional comments or information you wish to pass on to the race organiser:

* Required field


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