Important: Please read before entering. After completing this form you will be forwarded to our secure payment area (NOCHEX). You can pay your entry fee via credit or debit card. We can accept Mastercard, VISA, VISA Electron, Maestro, Switch and Solo but your card must be with a UK bank. If you are unable to pay with the above please download and complete an entry form in the usual way.
			Please select the race distance you wish to run: Select Race... Tarpley 10 Tarpley 20
			Runner Details:
	Title:
	Forename:
	Surname:
	Address 1:
	Address 2:
	Town/City:
	County:
	Postcode:
	Telephone:
	E-mail:
	Gender:		Male Female
	Date of Birth:		dd/mm/yyyy
	Age:		(on 26 February 2012)
	Category:
	Affiliated Club:		Leave blank if none
	UKA/Comp. Licence No.:		(If known)
	Paid by:		If the name of the person paying is not the same as the name of the runner please enter the name of the person paying above. This is to enable us to match-up payments from Nochex against the entries.
			Declaration: I am 16 years of age or older on race day (18 for the Tarpley 20). I declare that I am medically fit to take part in this event and I understand that enter at my own risk and that the sponsors, organisers or their servants shall not be held responsible for any injury, loss damage or action claim (howsoever occasioned) as a consequence of my participation in the event. If I have a medical condition, which may be affected by my taking part in this event, I will record it on the reverse of my race number. Also marking the front of the number with a red cross in the top right hand corner.
	By clicking the submit button you agree to the terms above, your entry will be forwarded to the Race Secretary and you will be transferred to our secure payment area Thank you for entering.