10K

FRIDAY, 12 AUGUST 2016 - START 7pm

St Levan Playing Field, B3315 between and , , TR19 6LR

Car park, toilets, refreshments and bag storage are available

Memento to all competitors - Closing date for postal entries 8 August 2016

All proceeds to St Levan Sports Club

NO iPODs, MP3s, HEADPHONES, MOBILE PHONES, ETC – INSTANT DQ! No dogs, wheelchairs or cycles – competitors cannot be accompanied or followed either on foot, cycle or vehicle

Incorporating round 10 of the Glass & Glazing Grand Prix Series

Various age group prizes including The Stephen Chapple Shield for first parish male and female: 1st 3 males overall, 1st 3 females overall (Prize giving approx 8.30pm) 1st 3 Males 15-19, 20-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ 1st 3 Females 15-19, 20-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70+ 1st 3 Male teams (6 to count) & 1st 3 Female teams (6 to count)

(Held under UKA rules and UK Licence No.2016-22616. Certificate of course accuracy no. SEAA 13/234) Open to 15-year-olds and above ………………………………………………………………………………………………………………

First Name……………………………….…….…………Surname…………...…………...………………….…………………

Address……………………………………………………...………………………………………………………………….…

………………………………………………………………………………………...………….Post Code…….………………

Telephone Number…………………………….…………………………………..…….………Male / Female …………..……

Email address……………………………………………….…...…………………………………….……….………………….

Age on race day …………………………………………………………. Date of Birth…….……./……….……./…………….

Name of affiliated Club…………….………………………………………Affiliation No. .……..……………...……….…..…

Do you live in the parish of St Levan or have ever gone to school there? Yes / No…………………………………..…………

Affiliated £11.00/ Non-affiliated £13.00 (£2 extra for entries on the day)

Cheques made payable to “St Levan Sports Club” - Receipt of entry will be emailed to you.

Race numbers to be collected on race day from Race HQ at St Levan Playing Field

Declaration: I declare that I am medically fit to run and will compete under UKA rules. I will not hold the organisers in any way responsible for any injury, illness or accident to my person or property arising from taking part in this event. Data Protection: The information you supply will be used solely for the purpose of race results and identification for health and safety reasons. The information will only be available to members of the results’ team and appropriate race officials and will not be passed to any other persons or agencies.

Signature …………………………………………………………………………. Date……………………………………… (Parent or guardian if under 18 years of age) Please return completed form to: St Levan Sports Club, 7 Atlantic Crescent, Sennen, Penzance, Cornwall, TR19 7AS [email protected] / www.mountsbayharriers.co.uk/mbh-events/st-levan-10k/