Surname: _________________________________________

First Name: ______________________Sex M / F: _________

Address: __________________________________________

__________________________________________________

_________________________ Postcode: ________________

Telephone (Including STD code):_______________________

Date of Birth DD/MM/YY:_____________________________

email address:______________________________________

Name of club / school: _______________________________

Please enter me for the Holly Run 2009. I declare that I will abide by the race rules; I am medically fit to run and understand that I enter at my own risk; and that the organisers will not be held responsible for any injury, loss or damages as a consequence of my participating in the Holly Run 2009. I understand that acceptance of my entry is subject to the approval of the Race Organisers and that after acceptance the entry fee is not refundable.
Races are run in accordance with BAF rules.

Entry Fees: All under 18's £2.00. For adults . . .
BAF Affiliated Club members £5.00, non-affiliated £7.00.

I enclose a cheque or postal order for the entry fee payable to REIGATE PRIORY AC, a large SAE (at least 9" x 6.5") for race information and number.

Signed: _________________________ Date:_____________