NIVAA TRACK & FIELD CHAMPIONSHIPS

MARY PETER’S TRACK, BELFAST, SATURDAY 30^TH AUGUST 2008

Entry Fee: Non-affiliated £7.00 first event. Affiliated £5.00 first event. Additional events £3.00 each

Cheques/postal orders must be made payable to ‘NIVAA’ (postage stamps not acceptable)

Male ____________ Female _____________

Please Use Capital Letters

Surname ______________________ First Name ____________________________________

Address ________________________________________________________________________

_____________________________ Post Code _________________________________

Telephone No: Home: ______________________ Work: ____________________________________

Mobile: _____________________

E-Mail: _______________________________________

Date of Birth: __________________________________ Age Group For Event: _________________

Club ______________________________ BMAF/IMAA Affiliation No ________________________

Non affiliated athletes please enclose copy of Birth Certificate/Driving Licence/Passport

Event PB 2007/08 Event PB 2007/08

1 _______________ _______________ 4 _______________ __________________

2 _______________ _______________ 5 _______________ __________________

3 _______________ _______________ 6 _______________ __________________

Payment Enclosed For Entry Fees

First Event - Non-Affiliated - £7.00 £ _______________

First Event – Affiliated - £5.00 £ _______________

Each Additional Event - £3.00 each £ _______________

Total £ _______________

I enclose a cheque/postal order in Stirling currency payable to ‘NIVAA’

I hereby agree that the organisers shall not be liable for any accident, injury, loss or damage as a consequence of my participation in the NIVAA Track & Field Championships.

Signed ____________________________________________ Date __________________________

Entries close on Saturday 23^th August 2008

Entries to: NIVAA Entries Secretary, 12 Upper Croft Road, Holywood, BT18 0HJ

SAE for confirmation of entry