By clicking the “Submit” button, you agree to pay for up to 4 runners for £420, of which £120 is the registration fee and a minimum £300 donation.  Please note that the £300 is a minimum and any additional donations or fundraising (sponsorship) will be much appreciated.  NOTE: Your place is not guaranteed until you receive confirmation from us that your registration fee has been received).

Full Name (Team Contact)

Address

Town/City

County

Postcode

Daytime Telephone

Mobile

E-Mail Address

Date of Birth  (dd/mm/yyyy)

Sex

How did you hear about this event?

Free Competitor's Singlet

Team Member Name 2

E- Mail # 2

Sex # 2

DOB #2 (dd/mm/yyyy)

Team Member 2 Singlet

Team Member Name 3

E - Mail # 3

Sex # 3

DOB #3 (mm/dd/yyyy)

Team Member 3 Singlet

Team Member Name 4

E - Mail # 4

Sex # 4

DOB #4 (mm/dd/yyyy)

Team Member 4 Singlet