Manchester Christmas Pudding 5 Mile Dash - Event Entry

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Entry Form Details: Manchester Christmas Pudding 5 Mile Dash, 25/11/2012 - 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):

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

* Required field


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