Luton Marathon Relay Entry Form

LUTON A.C Summer Series LUTON A.C Summer Series 37th Luton 10K 37th Luton 10K Sunday 16th July 2017 Organised by Luton A.C Sunday 16th July 2017 race start time 11.00am. Venue 360, Gypsy Lane, Luton, LU1 3JH Under UKA Rules (UKA Licence No. applied for)

Medal to all finishers.

Team Prizes: Seniors/Vets/Ladies – 4 to score.

One lap course using Luton Hoo private road. Excellent facilities, bar, food, changing areas, car park and refreshments at finish.

First Aid cover to Level 1 on all races

Pre Entry Fees: Individual race £10 - UKA Competition member £12- Non UKA Competition member Return entry form with payment to: - Race Secretary, 12, Ringwood UKA Competition members who do not provide their licence number Road, Luton, Beds. LU2 7BG (no SAE needed) will be required to pay the £2 levy. Race details and online entry can be found on Entry on the day entries fees: http://www.lutonac.co.uk Individual race £12 - UKA Competition member £14 - Non UKA Competition member UKA Competition members who do not provide their licence number will be required to pay the £2 levy LUTON SUMMER SERIES 10K ENTRY FORM

th Entries: Closing date for postal entries will be Monday the 10 July (PLEASE PRINT CLEARLY) 2017. Surname ______Return entry form with payment to: - Race Secretary, 12, Ringwood First Name ______Road, Luton, Beds. LU2 7BG, Cheques payable to ‘Luton A.C’, we are Address ______unable to accept postal orders (no SAE needed) Town ______County ______Post Code ______Telephone ______Email Address ______UKA Affiliated Yes / No Licence No ______Club ______Sex M / F Date of Birth _____/____/______Age on Day ______

Declaration: I hereby declare that (1) I am 15 or over on Race day (2) I am an amateur according to the eligibility rule of UK Athletics, (3) I am medically fit to run and (4) I will do so at my own risk and agree not to hold the organisers responsible in any way for any injury or loss resulting from my participation in the event (5) In the unfortunate cancellation of the event through circumstance beyond the control of the race organisers. I understand, and accept, the rules and terms of the entry including that there will be no refund of race fees.

(Signature of this form indicates acceptance of UKA rules).

Signature______Date _____/_____/_____

Fee enclosed £______Cheque payable to “Luton A.C” (we cannot accept postal orders)

The information contained in this entry form will be stored on an electronic database, under the terms of the Data Protection Act, for the purposes of this event and for mailing details of future events