Stephensons
Tholthorpe 10K Entry Form 6th Sept 2009 11am
Entry - £7 affiliated - £9 unaffiliated - £1 extra for entries received after 30th August. Minimum age for runners is 15.
Please return, with correct entry fee and SAE, to;
Tholthorpe 10K. 4 The Orchard, Tholthorpe, York YO61 1SX by 30th August. (Cheques payable to "Tholthorpe 10K")
Surname First name
Address
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Post Code................................................................................................................................................
Contact Phone Number..................................................................................................................................................
E-mail address...................................................................................................
I live within 5 miles of Tholthorpe YES/NO (Please delete one)
If you live in North Yorkshire or are a member of an affiliated North Yorkshire athletics club, you qualify for the N Yorks Championship. YES/NO (Please delete one)
Category on race day (please tick)
Male under 40 Female under 35 ..
Male 40-49 . Female 35 44 .
Male 50-59 . Female 45 -54
Male 60 + Female 55+
If you are a member of a BAF affiliated club please state which
I hereby declare that I am an amateur as defined by BAF rules and I am medically fit to run 10 kilometres (6.2 miles). I understand the organizers of the event will not be responsible for any loss or injury to my person as a result of this event.
Signed ..Date