CLUMBER PARK DUATHLON 2010 - ENTRY FORM

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					                       CLUMBER PARK DUATHLON 2010 - ENTRY FORM
                  IN D IV ID UA L & T EA M E V E NT - SPR I NT & CLA S SI C D I STA NC E EV E NT S
                                      BRI TIS H DU AT HL O N C HA M P I ONS HI PS
                   WO RL D & EU RO P E AN 2 0 10 C H A MP I ONS H I PS – QU AL IF Y IN G EV EN T
                                           SA T UR DA Y 6 T H MA R CH 2 01 0
            CL UM B ER P A R K , C L UM B ER GA R D E N S, W OR K S OP , N O TT I NGHA M SHI R E , S8 0 3 A Z
                                     PLEASE COMPLETE THIS ENTRY FORM NEATLY IN BOLD CAPITALS

EVENT DETAILS

NAME                                                                  SURNAME

DATE OF BIRTH                                                         AGE

GENDER                       MALE                  FEMALE             (PLEASE DELETE)

ARE YOU A MEMBER OF THE BRITISH TRIATHLON? YES / NO.                  IF YES BRITISH TRIATHLON NO.:

DO YOU WISH TO COMPETE IN THE WORLD AND / OR EUROPEAN CHAMPIONSHIPS IF SELECTED? YES / NO

ORGANISATION/CLUB:

IF ENTERING A TEAM PLEASE COMPLETE TEAM NAME:

T-SHIRT SIZE:                SMALL                 MEDIUM             LARGE               EXTRA LARGE         (PLEASE CIRCLE)

WILL THIS BE YOUR FIRST DUATHLON?

ADDRESS

POSTCODE

EMAIL                                                                 TELEPHONE

HOW DID YOU HEAR ABOUT THIS EVENT?

DO YOU HAVE ANY MEDICAL CONDITIONS OR DISABILITIES?

EMERGENCY NAME & CONTACT DETAILS:

ENTRY FEES – PLEASE TICK

CLASSIC DISTANCE
  BTF MEMBER = £37.00           NON BTF MEMBER= £42.00                   RELAY TEAM = £47.00 + BTF LICENCES @ £5.00 PER NON MEMBER


SPRINT DISTANCE
  BTF MEMBER = £32.00           NON BTF MEMBER= £37.00                   RELAY TEAM = £42.00 + BTF LICENCES @ £5.00 PER NON MEMBER
                                       TH
   I AM ENTERING AFTER FEBRUARY 25          & HAVE ADDED £5.00 LATE ENTRY FEE
I (on behalf of the above team) declare that I/we will abide by the rules of BRITISH TRIATHLON and accept that One Step Beyond Promotions
and their friends and associates are not liable for any loss, damage claim or expense which may arise in consequence of my participation in
the event, no matter how caused. All athletes must obey the Highway Code. I have read & agree to abide to the Terms & Conditions of
Entry. Tick box if you do not wish to receive details on future events & promotions relating to this event.

  Please tick the box if you would prefer us not to share your details with our industry related product and service partners)

Signed:                                                               Date:
                                     Please make cheques payable to: One Step Beyond Promotions Ltd
                                                        Send completed entry form & cheque to:
                                            Clumber Park Duathlon, One Step Beyond Promotions Ltd
                                            White House Farm, Maltkiln Road, Fenton, Lincs. LN1 2EW
                                            Tel 01427 718888   Email clumber@onestepbeyond.org.uk
                             *NB. Only the first 500 complete entries received are guaranteed a place in the event
    DATE RECEIVED            SAE’S                      £                            SIGNED                     NOTES

				
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