* indicates required entry
First Name *
Surname *
Address Line 1 *
Address Line 2
Town *
Postcode *
Telephone *
Email Address *
Payees name (if not entrant)
ARC / UK Athletics Affiliated? *
Yes No
If Yes:
Club
Registration No.
Gender *
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Age on Race Day * (26/02/2012)
T-shirt size *
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Disclaimer: I declare that I will take part in the event entirely at my own risk, that I have no medical disabilities that may endanger me or other participants, and that I remain personally responsible for my own property at the race venue. As a race entrant I am over 15 years old. Accept
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