Blandford Stour Rotary Santa Fun Run and Walk
10 December 2017
Registration Form
Please right click to print this registration form and when completed, signed and dated return it to:
Rotary Santa Run, Little Monnington, The Cliff,
Bryanston, DT11 0PP
or scan and email to: blandfordsantafunrun@outlook.com
Check in will be open from 9.30 am for the start of the event at 10.00 am
Please print clearly Tick here if intending to run the 5 mile course O
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First name |
Surname |
Adult or youth
£5 |
Under 8s
£2.50 |
1
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2
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3
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4
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5
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Total |
£ ________
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Address ...................................... E-mail:
...................................... Telephone no:
.......................................
Post code........................
Payment method O By cheque O Cash on the day
Please include your cheques made payable to Blandford Stour Rotary Club
Declaration:
In completing this form I/We declare that I/We are medically fit to take part in this event and understand that I/We enter at our own risk and that no person or organisations will be held responsible for any accident, injury or loss of possessions prior to, during and after the event.
Signed:
…………………………………………………………………....
Date: ……………………………………………………………..
UNDER THE TERMS OF THE DATA PROTECTION ACT 1984 WE ARE REQUIRED TO INFORM YOU THAT INFORMATION PROVIDED IS FOR SANTA RUN ADMINISTRATION ONLY AND WILL NOT BE USED FOR
ANY OTHER PURPOSE
Registered Charity No: 1079916