Charity No: 1061840
Charity No: 1061840
This event is being run in support of Carers Support, West Wilts to whom all profits will be given
Team Name:
Team members: - Details of team members may be submitted later, up to two weeks before the event.
| Name | Age | Gender | 1st leg | 2nd leg | |
|---|---|---|---|---|---|
| 1 | |||||
| 2 | |||||
| 3 | |||||
| 4 | |||||
| 5 | |||||
| 6 | |||||
| 7 | |||||
| (8) | |||||
| (9) | |||||
| (10) |
Runners, Spectators and Officials all take part in this event entirely at their own risk and the organisers will bear no liability for any loss, damage or injury to anyone taking part or watching.
Team Captain:
Club Name:
Address:
Post Code:
Telephone:
Is the club UK:A affiliated: Y / N
I have read and agree to the Rules for this event
Signature of Team Captain:
e-mail:
Date:
Entry fee paid: £70
Please note that there is a surcharge of £2 per head for every non-affiliated runner which will be paid to England Athletics.
Make cheques payable to The White Horse Relay
Return this form to: Anthony Hickson, 15 Sandridge Road, Melksham, Wiltshire, SN12 7BE
