S.A.R.K. 10

Please print this form, complete it and send it with the appropriate fees to:
S.A.R.K., La Connellerie, Sark, Channel Islands, GY9 0SF.

Please enter me for the following race: - tick appropriate box below: -

□	5 KM Race	12.00 p.m.	£ 7 (£ 10 on the day)
□	10 Mile Cross Country Run	12.00 p.m.	£ 10 (£ 15 on the day)
□	2.5 Mile Children's Race	2.00 p.m.	£ 4

Surname	_______________________________________________
Forename	_______________________________________________
Address	_______________________________________________
City	_______________________________________________
Postcode	__________________
Country	_______________________________________________
Age on the day	___________(max. age for Children's Race is 14 years)
Date of birth	____/____/_______ Sex : Male/Female
Telephone / mobile	_______________________________________________
E-mail	_______________________________________________

Please make cheques payable to S.A.R.K.

Declaration: I am medically fit to run and understand that I enter at my own risk
and that the organisers will in no way be held responsible for any injury to my
person during, or as a result of the event, nor for any property lost on or near
the course or changing areas.

Signed:	___________________________(Parent/Guardian if under 16 years)
Date:	_____/_____/__________