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SWVAC OPEN 10km Road Race & Race Walking Championship

Portland, Dorset

Organised by: South West Veterns’ Athletics Club in accordance with UKA rules. Permit No. SEAA Course measurement Certificate No. TBA

Sunday 12th October 2008

Race starts at 11am

Portland United FC, The Grove, Portland, Dorset.

CLOSING DATE 1^ST October 2008

UNDULATING COURSE

Entry Fee (Non Refundable): £5.00 Affiliated Competitors, £7.00 Non- Affiliated Competitors.

ENTRIES ON THE DAY - £2 EXTRA -GUEST RUNNERS WELCOME

(Cheque payable to ‘South West Vets AC’)

Parking at venue; limited changing and shower facilities; Not suitable for Wheelchairs.

Championship Medals for 1st, 2^nd & 3^rd in all 5 Year Age Categories Male and Female from 35 up.

Complete and Detach the Entry Form, send appropriate fee and a S.A.E. (9"x6") to: Race Secretary, 7 Sandford Court, 32 Belle Vue Road, Bournemouth, Dorset BH6 3DR (01202 429137). E-mail:- k.ballam@btinternet.com.

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SWAC OPEN 10km Road Race & 10km Race Walking Championship –

ENTRY FORM

PLEASE COMPLETE ALL DETAILS IN BLOCK CAPITALS

Surname……………………….……………………..Forename(s)..…………….…………….......…………..…

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

………………………………………..…………………………………………Postcode……….…………….…

Date of Birth………...…….Gender M/F……..Tel Numbers & STD Code(Home)……………………………

E-Mail………………...........................................................................................………..…………...…………..

Affiliated Club………………………………..…….…….Membership No…………….....……………

I declare that I am an amateur as defined by UK Athletics. I agree to abide by the current laws of competition of UK Athletics.

I am medically fit to run. I agree that I enter at my own risk and that the organisers will in no way be held responsible for any injury, illness, accident to my person or loss of my property as a result of my participation in this event. I also understand that no refund can be given in the event that the race is cancelled due to circumstances outside the organiser’s control, or if I am unable to compete due to illness or injury. Data Protection Act: Entry details may be stored on a computer disk. It will not be possible to process Entries for anyone who objects to having his/her details so recorded. Submission of this entry is taken to indicate that the entrant does not object to having his/her details so recorded

Signature………………………………………….………………..Date………..……………...