4. 4
/ Entry Form
2010 ULTRAMARATHON 10 HOURS
1 2553 / Saturday 1st May 2010
(Name).................................................................................................................
(Date of Birth)............................................. (Age)....................
(Nationality)................................................. (Sex)................................
(Running T-Shirt Size)..............................................................................
(Team/Club)...............................................................................................
(Address)...........................................................................................................
.....................................................................................................................................
(Post Code).........................................................................................
(Tel)............................................E-mail...............................................................
(Category)
ULTRAMARATHON 10 HOURS (Fee) 1,000
........ (MaleOpen) ........ 50 (Male 50 & Above)
........ (Female Open) ........ 50 (Female 50 & Above)
RELAY ULTRAMARATHON 4 X 2.30 HOURS (Fee) 2,000
........ 4 X 2.30 ( )
1...........................................................................
2...........................................................................
3...........................................................................
4...........................................................................
WAIVER STATEMENT
I certify that I am medically fit to compete and fully understand that I enter at own risk, and the
organizers will in no way be held responsible for any injuries,illness or loss, or as a result of the
event.
/Signature.................................................................
................../......................2010
/ Reproducing of this form is permitted.