Withernsea 2.2km Fun Run - The Entry Point

Payment Options

Entry Options - Please choose an option below

	£3.00 - 2.2km Fun Run
	£0.50 -

Personal Information

* Title

* First Name

* Last Name

* House Number/Name

* Street Name

Address 1

* City

* Area

* Post Code

* Country

* Gender

* Date of Birth

* Your Age Please note that the minimum age permitted for this event is 7)

* Telephone Number

* Email

* Confirm Email

* Club (Please enter N/A if you are not a member of a club)

Parental/Guardian Consent

It appears that the age submitted has shown that you are under 18 years of age.

This form must be completed by a parent/guardian of the athlete taking part. Please state the name of the person filling in this form and your relationship to the named athlete.

*Please Enter Parent/Guardian Name

*What Is Your Relationship To The Athlete?

I am giving permission for the athlete entered on this form to participate in this event.

Donation

We would be delighted if you could make an additional donation to our nominated charity: Withernsea Lifeboat Station. Any amount large or small would be really appreciated.

£

I am a taxpayer and wish for my donation to be made under provisions of the Gift Aid Scheme

Terms and Conditions

I agree with the terms and conditions .

Important Entry Information

To manage this Entry effectively we will need to send you important information by email. We will be providing information that we really need you to see. We will only send you information regarding the Entry itself and will not use your email address for any other purpose.