Harewood – Trail Race & Junior Race / Fun Run – 4 October 2009 – Entry Form

EVENT ENTERED 10miles trail o    2miles junior / fun run o    (tick appropriate 'box')

First Name _____________________ Surname _____________________________

Address _____________________________________________________________

_____________________________ Postcode _________ Date of Birth ___________

Telephone Number _______________________________ Age on Race Day ______

Club / School / Organisation _________________________________ Sex (M/F) __

UK Athletics Registration Number ____________________

email address ______________________________________

DECLARATION: I declare that I am an amateur according to U.K.Athletics laws. I understand that I take part entirely at my own risk and accept that the organisers shall not be liable for any injury or illness to my person as a result of taking part, nor for any damage to or loss of property.

Signature ____________________(signature of adult if 16 or under)       Date______________

Fee Enclosed ______ Additional (optional) donation to our charities enclosed _______

10 mile: £8.00 UKA affiliated / £10.00 unattached
2 mile: £3.00 junior / £5.00 adult
- cheques payable to Lineham Farm Children's Centre

Please enclose a stamped self-addressed envelope unless you intend to collect your number on the day.

Gift Aid: Please help us to make your ‘additional’ donation worth even more. If you are a taxpayer our charities can reclaim the tax from this - currently 25p from every £1 given. Please tick here o if you pay UK Income or Capital Gains Tax and you wish our charities to reclaim the tax on your donation   NB we can only reclaim on the additional donation, not on the entry fee.

If you require a Sponsorship Form to be sent to you (no obligation) or would like more information about our charities, please see the website

Click for entry details

Click for link to main page for Harewood Trail & Hop races