ENTRY FORMS FOR 3COUNTIES10K
Please Fill out with Black Ink, Fields marked with * is a must and Please make your cheque
payable to Three Counties10k Ltd and please mail to:
THREE COUNTIES 10K LTD
24 Cypress Grove
Ash Vale
Surrey
GU12 5QN
PERSONAL INFORMATION
DATA PROTECTION ACT
Email:
A photograph or broadcast which includes
your participation in the race may be used
by Three Counties10k Ltd, or its agents, and
by Sponsors of the Event for the purposes of
Marketing/PR. If you do not wish your
details to be used for this purpose,
Please tick here.
* First Name
* Surname
Three Counties10k Ltd offer a searchable
database of photographs of participants for
sale to the public via their website and for
this purpose 3Counties Ltd may forward
them with your name and race number.
* Address
City
Your name and address will be used by
Three Counties10k Ltd or its agents for
notification of future activities, including
road races and cross country mountain bike
race. If you do not wish your details to be
used for this purpose, please tick here.
* Postcode
Telephone Day
Telephone Evening
Mobile
* Date Of Birth
Details given on this entry form may be used
by Three Counties10k Ltd or its agents for
the purpose of race commentary and points
of interest. If you do not wish your details to
be used for this purpose, please tick here.
Emergency Contact
Name
Emergency Contact
Phone
I wish to receive Active
Emails which include
future events.
Yes/ No
OTHER PERSONAL INFORMATION
* Gender
LIABILITY STATEMENTS
Male/ Female
15 Kilometre Run
£15
10 Kilometre Run
£14
5 Kilometre Run
£10
Three Counties10k Ltd. Are holding the
event to help raise money for various
charities who are not involved or
responsible for the planning or execution of
your chosen run and would not or do not
accept any liability for injury or distress
Are you entering as part
of a team?
Yes/ No
occurred to competitors or persons involved
in during or after your chosen run.
The 15k 'Devil Run', 10k and 5k cross
country have been organised by Three
Counties10k Ltd,
You are required to be physically fit and
willing to accept the challenge without any
recourse to the above company or to The
National Trust.
The National Trust allow us the facility of
their land but the National Trust are not
involved in the preparation or execution of
the run and are in no way liable for any
injury or distress caused to competitors or
any person associated with the person
running. Three Counties10k Ltd DO NOT
accept any liability for injury during or after
the 15k 'Devil Run', 10k or 5k Cross Country
Run.
Competitors agree to take part in the events
accepting the risks involved and do not hold
the organisers responsible for injury or
damage during the runs.
By entering the event you are agreeing to
the terms and conditions of the events.
* Please supply name of
Team/ Organisation and
address.
* Do you have a medical
condition we should
know about? If yes tell
us
What charity/
organisation/ sport club
are you running for?
PLEASE GIVE DETAILS.
Please note: it is the
responsibility of the
individual entrant to
contact their chosen
charity.
Tell us your story
briefly: