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Race _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2002
Admin _ _ _
_ _
Surname _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ First Name _ _ _ _ _ _ _ _
_ _ _ _ _ _
Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Fee Enclosed
_ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ �10/�14 for all 4
races
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Club/unattached
Club or Unattached _ _ _ _ _ _ _ _ _ _ _ _ _
U/A or Members
of Clubs not Affiliated to UKA must pay �1.00 levy
Male or Female _ _ _ _ _ Age on race day _ _ _ _ _
NoEAA
Membership Number_ _ _ _ _ _ _
I declare that I enter at my own risk and
that the Organisers will not be held liable for
any damage or injury caused by my
participation I am an amateur under UKA rules
Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Date _ _ _
_
Please
enclose Sae 9"x6"for number and info.
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