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GLOUCESTERSHIRE A

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					                              ENTRY FORM
        GLOUCESTERSHIRE A.A.A. 10,000 METRES TRACK CHAMPIONSHIPS
                     WEDNESDAY 25th AUGUST 2010

Venue:           Prince of Wales Stadium, Tommy Taylor's Lane, Cheltenham.

Start Time:      6.55 p.m.

Age Groups: Junior, Senior and Veteran Men and Ladies

Entry Fee:       £3.00

Entries to:      Marion Loveridge, 75 Merevale Road, Elmbridge, Gloucester, GL2 0RF.

Please make cheques payable to Gloucestershire AAA and enclose a Stamp Addressed Envelope
for return of number. Numbers must be collected from the Registration Desk on the day for
entries received after Friday 20th August 2010.

Eligibility:     Athletes must have been born in Gloucestershire, resident in the county for at
                 least 9 months or serving in the county in H.M. Forces for at least 9 months
                 to be eligible to compete in the Gloucestershire championships and to receive
                 county medals.

Guest Competitors: GUESTS ARE ALLOWED TO COMPETE BUT WILL NOT BE
                   ELIGIBLE FOR COUNTY MEDALS.

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ENTRY FORM - GLOUCESTERSHIRE AAA 10 KM TRACK CHAMPIONSHIPS                                                       No.
WEDNESDAY 25th AUGUST 2010 AT 6.55 P.M.

Name ____________________________________________________________

Address: _____________________________________________________________________
         _____________________________________________________________________

Telephone Number: ______________________________________

Age on day of race: ___________                      Club: ____________________________________

Male/Female (please delete as appropriate)

County Champs Competitor/Guest Competitor (please delete as appropriate)


Signed: ____________________________________                           Date: _____________________