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Name:...............................................................................................................
Address:............................................................................................................................
..........................................................................................................................................
Club.................................................................................Telephone..................................
Male
Female
Date of Birth: ........./......../......... Age on
race day:..... (10k entrants must be 15 or over)
Athletics Scotland or other UK Club Member?
Yes
No
Membership No.
......................................
Entry fees:
Laggan 10k
Laggan 10k. £8 (or
£10 if non Athletics
Scotland Member or other UK club member)
Fun Run
Fun
Run £2
I enclose a cheque for £..................
Payable to "Pat Goddard"
Please send to: Strathmashie House, Laggan
Bridge, Highland. PH20 1BU. UK.
Please include a SAE to receive your race
number.
Any enquiries: email: pat@strathmashie.co.uk
or telephone: 01540 664945
I wave any right and claims
against the organisers for any loss/injury
as a result of participating in this event.
Signed:
......................................................Date:
.........../.........../.2009.. |