Corfe Mullen
Carnival
5km
and Junior 1 mile fun run
(www.cm5k.co.uk)
run
In aid of: -
Tuesday 13th June 2017
at 7:00pm (1 mile) and 7:30pm (5 km)
Recreation Ground, Badbury View Road,
Corfe Mullen, Wimborne, Dorset, BH21 3HU.
Entry fees:
£5.00 - 5km run
(Adults and juniors aged 14 and over),
£3.00 - Junior 1 mile run
(Juniors aged 8 to 13 years).
« Trophies for podium finishers in all events «
« Medals for all junior finishers «
«Trophies for first male and female non-club runner
living in Corfe Mullen«
ü
ü
ü
Entry forms and further information can be found at “www.cm5k.co.uk”.
Please support our charities and race sponsors.
On the day entry fee will be £6.00 (5km) & £4.00 (1 mile).
Corfe Mullen Carnival Run – 13th June 2017
Please complete entry form clearly and in block capitals
Full name:
Address:
Email address:
Contact telephone no:
Name of club/team (if applicable):
Date of birth:
Age on race day:
Male / Female (delete as appropriate)
Race no.
Race entered:
(For official use only)
5 km
1 mile
I declare that I am medically fit to take part in the event and confirm that the
organisers and sponsors shall not be liable for any accident, injury, loss or damage
caused as a consequence of my participation. I agree to abide by the event rules as
published on the event website. I confirm that I will be the correct age on race day
for the event that I enter.
I enclose a cheque made payable to “C M Running” for £
(Enter £5.00 for
5km or £3.00 for junior run) to cover my entry fee. I would also like to make a
voluntary donation of £_______ to go towards the carnival’s nominated charities.
Data protection: By submitting this entry form I agree that the organisers may store
my details and results on computer disk for the purpose of race administration. I also
agree that photographic and video footage may be taken by authorised personnel
for both marketing purposes and the CM5K website.
Signed:____________________________________
Date:_________________
(Parent or Guardian to sign if entrant under 18 years of age)
Please complete this form, and send it to: Corfe Mullen Carnival Run, c/o Richards Estate
Agents, 147 Wareham Road, Corfe Mullen, Wimborne, Dorset, BH21 3LA. INCLUDING A
STAMPED ADDRESS ENVELOPE for posting your race number prior to the race.
The last date to receive postal/hand delivered entry forms, will be Saturday 3rd
June.
Each entrant should complete a separate form. A photocopied form is acceptable. Please
note: Entries on race day will be £6.00 for 5km and £4.00 for 1 mile fun run and may be
subject to places being available.
We regret the course is not suitable for wheelchairs.
Further information about the event can be found at “www.cm5k.co.uk” or
visit our Facebook page “@CorfeMullenCarnival”