Please complete on screen, print by clicking print from your Explorer menu bar(set margins to minimum), then click button at bottom, sign & send printed copy in post with cheque PLEASE NOTE CLOCKS GO FORWARD 1HR:

OFFICIAL ENTRY FORM

"THE EQUITY INSURANCE GROUP" BRENTWOOD HALF MARATHON AND FUN RUN

SUNDAY 25^th MARCH 2007

SEAA Permit Number: 7096 (Half Marathon)

Please complete all parts of the entry form in BLOCK CAPITALS

EVENT

Please indicate which race

Half Marathon (Minimum Age 17)

Fun Run (Minimum Age 8)

SURNAME

FORENAME

ADDRESS

PHONE (Contact)

E-Mail

TOWN

Please indicate: MALE

or FEMALE

COUNTY

Post Code:

AGE on 25 March 2007

TEAM OR CLUB NAME (if applicable)

Estimated Race Timehrmin

(Please note, if entering a team, every member must complete an entry form)

COMMEMORATIVE T-SHIRTS MAY BE ORDERED IF REQUIRED at an extra cost of £8 & collected on the day from Info desk

Please tick the box appropriate to your size and include the cost in your remittance.

SMALL

MEDIUM

LARGE

XLARGE

XXLARGE

We are happy for entrants to raise monies for charities of their own choosing. However if you would like to make a personal donation (payable with the entry fee) to the Rotary charities supported by this event, please indicate below.

ENTRY FEE		Affiliated to South of England Athletic Association (SEAA)?		Yes		No
Half Marathon		17 and over Affiliated to SEAA	Entry Fee £11.00
		17 and over Not Affiliated to SEAA	Entry Fee £13.00**
Fun Run		17 and over	Entry Fee £9.00
		8 years to 16 years inclusive	Entry Fee £5.00
T-Shirts (if required)		Please State Size above	T-Shirt £8.00
			Personal Donation
			TOTAL AMOUNT ENCLOSED			£

** The extra £2 is sent to UK Athletics to fund athletics in this country.

SAE must be enclosed if results sheets required. All results will be printed in the Brentwood Gazette and posted on the Web at www.brentwood-a-becket.org.uk

Please return your cheque or postal order, made out to BRENTWOOD CHARITY FUN RUN, together with the completed entry form to:- BRENTWOOD CHARITY FUN RUN, BRENTWOOD BOROUGH COUNCIL, TOWN HALL, INGRAVE ROAD, BRENTWOOD, ESSEX. CM15 8AY

Race packs will be posted out March ‘07. If not received by 21^st March, Email/phone us & report to Info desk on race day.

NB. Un-returned timing chips will be charged at £10.00 each.

Important

The lower age limit for the Fun Run is 8 years. For the Half Marathon lower age limit 17 years (in accordance with SEAA’s rules).

It is a condition that children under 12 years of age are accompanied on the run by a responsible adult and that PARENTS OR GUARDIANS COUNTERSIGN APPLICATIONS FROM ALL CHILDREN UNDER THE AGE OF 16 YEARS.

Please enter me in the The Equity Insurance Group Brentwood Half Marathon/Fun Run 2007. I am medically fit to run, and understand that the organisers, sponsors or any assisting person or persons will in no way be held responsible for any injury, illness, loss or damage to my person or property incurred during or as a result of the event, or for any damage caused by me to other persons property. I agree that photographs taken may be used for publicity purposes only. Entry fees are non-refundable.

The organisers reserve the right to refuse entry for any reason. Postal entries close on 19th March 2007

SIGNED:

DATE:

(Parent or Guardian to counter-sign applications for entrants under the age of 16)

Please return the form as soon as possible – do not leave it to the last minute!

Half Marathon Entries on the day will be charged at £14 and Fun Runners 17yrs+ £10

PROBLEMS OR QUERIES ? E-MAIL: babrc2007@btconnect.com or RING THE HOTLINE 01277 312638

The 26^th Charity Race ORGANISED BY THE ROTARY CLUB OF BRENTWOOD à BECKET

Registered as a Charity

Supported by: Equity Insurance Group, Brentwood Borough Council and Brentwood Gazette & Mid Essex Recorder