IAU 100Km World Cup Under the Patronage of IAAF

IAU 100K WORLD CHAMPIONSHIP IAU 100K EUROPEAN CHAMPIONSHIP Winschoten - September 10th 2011

PRELIMINARY ENTRY FORM (=PEF) To be returned before July 2nd 2011

Federation : (IAAF-abbreviation) We are pleased to confirm our intention to participate in the above mentioned event and our delegation will consist of:

Number of athletes (maximum 9 men and 9 women) MEN’S RACE: WOMEN’S RACE: Note: ALL runners who like to participate in the WMA World championships 100km,-2011 must also be entered ONLINE through the LOC website: www.runwinschoten.nl, (and pay the required entry fee of 34.50 Euro) Number of OFFICIALS: Number of EXTRA CREW MEMBERS (SUPPORTERS)

Please read the regulations about the limited number of Officials in the General Information Sheet The LOC TRAVEL GRANT will be paid

O On this bank account: IBAN code: BICCODE: Name of the owner of this account:

Only in exceptional cases, the IAU will pay the travel grant on site O on site to (name of the eligible person): Mr/Mss

Name and signature:

Position in Federation:

Please return this form by e-mail before July 2 nd 2011 to:

E-Mail General Secretary IAAF [email protected] General Secretary IAU [email protected] LOC [email protected]