Tarpley 10 Entry Form | saint edmund pacers

	tarpley 10

Tarpley 10 - 2008 Online Entry Form

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 complete an entry form in the usual way.
First name:
Surname:

Date of birth:(DD/MM/YYYY)	/ / eg. (01 / 12 / 1974)
Age on race day	Note: Minimum age 17 years on race day

Affiliated Club (Leave blank if none)

Address line 1:
Address line 2:
Town / City :
County :
Postcode :
Country :
Telephone :
email address:
Declaration :	I am 17 years of age or older on race day. 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.
Tick box to accept declaration above
By clicking on submit button below your entry will be forwarded to the Race Secretary and you will be transferred to our secure payment area Thank you!