The Exbury Gardens 10K
Sunday 15th March 2009, 10.00am

Entry Form

Surname:
Forename(s):
Address:
Postcode:
Telephone:
Club Name:
Age on Race Day (min 15yrs):
Date of Birth:
Male/Female: Male: Female:
E-mail:
Print the form:

Entry Fee: £10 (£12 Unaffiliated) (No entries on the day)
Cheques made payable to The Exbury Gardens 10K

I declare that I will abide by the UKA rules. I am medically fit to run and understand that I enter at my own risk and that the organisers will not be held responsible for any loss, damage, action, claim, injury or illness which may arise as a result of my participation. Minimum age: 15 years on race day.

Please send completed form with 9X4 SAE by 6/March/09, plus cheque to Race Secretary:
Exbury Gardens 10K, 12 Sunningdale,Hythe, Southampton. SO45 5BD
Signed: 
Date: