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

	First name	Surname	Adult or youth  £5	Under 8s   £2.50
1	-----------------------------	-------------------------------------	-------------	---------
2	-----------------------------	--------------------------------------	--------------	----------
3	----------------------------	--------------------------------------	--------------	----------
4	----------------------------	--------------------------------------	---------------	----------
5	----------------------------	--------------------------------------	---------------	----------
		Total	£ ________

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