Lee Valley 10K & 3K Charity Fun Run
Helping others through life


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Entry Form

Run Entry   Team or Individual Entry
10km
 Fun Run  
Individual
 Team

Your Details

Full Name:
Age (on the Day)
Sex
Male Female
Address
Address
Town
County
Postcode
Home Telephone
Mobile
Email Address

Additional Runners ( As team captain, all information will be distributed to you to distribute to your team)

Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female
Full Name
Age (on the day )
Male Female

10km runners only

Are you a member of a club
YES NO Club name
Is your club affiliated to a UK Athletics?
YES NO
 

Total Payment

 No of runners Price Total
10km Run
£10.00*
 £ * .
Fun Run - Adults
£5.00
 £
Fun Run - Children
£5.00
 £
Total Entry Fees payable
£

How did you hear about the event

Email from LVRPA Poster ( where?)
Email from Noah's Ark Website ( Please specify )
Direct Mailing Magazine/Publication (which one?)
Word of mouth Sports/Leisure Centre (which one?)
Herts Multiple Sclerosis Therapy Centre Other ( Please specify )

Declaration - I understand and agree that I and my team members participate in the event at our own risk and that no responsibility whatsoever shall attached to the race organisers or partners involved in the organisaton of the event for any accidents, loss or damage suffered by us, or by reason of the event, however such may be caused. I / We have no medical conditions that will affect my/our safe participation in the event.

I have read and understood the above and sign to the agreement of the above and the event terms and conditions.

Cheques made out to "The Fun Run"

Send to The Fun Run

69 Ampthill Road

Shefford

Beds SG17 5AZ