Please Complete All White Sections - Write Clearly And In BLOCK CAPITAL Letters

Entry Form for Wessex League 2014-2015

Please complete all white sections - write clearly and in BLOCK CAPITAL letters.

Section 1: To be completed by participant:

SURNAME: SECTION 2: To be completed by race administrator:

RACE FIRST NAME: NUMBER:

DATE OF BIRTH: dd/mm/yy

GENDER Please circle MALE / FEMALE

UKA ATHLETICS CLUB

Race Administrator use only:

Transfer information to First Aider MEDICAL information sheet CONDITIONS: YES / NO

FEE PAID: N/A Race Administrator use only:

ADDRESS:

POSTCODE:

EMAIL: PHONE:

I have read the conditions of race entry. (Displayed on side of marquee) and agree to read and complete reverse of my number.

SIGNATURE: DATE:

Forms to be returned one week before the first fixture via post to Lindsay Hole, 10 Meadowsweet Road, Creekmoor, Poole, Dorset BH17 7XT.