--------Please print off this form , fill in the required details -------------------------------------and send this off with the correct fee (as below) to :--------------------------------Tim Greenwood (Milland) , 23 Kingswood Firs , Grayshott , -----------------------------------------------------------Hindhead . GU26 6ET----------------------------------to receive race number and pre.race instructions                             (no SAE needed)

----------Fees : Club Runners affiliated to English Athletics £9---------------------------------------        All other competitors £11                  --------------------------------               Cheques payable to Liss Runners.-----------------------------

Club Runners registered with England Athletics please list your club here.................................. Please be honest. We may check if you                           are registered!  

First Name : ............................       Surname : .................................

Age on 01.08.10 : ................ (minimum 18 years old)                 

Date of Birth : ................

Address : ......................................................................................................

......................................................       Post Code : ......................................

Telephone Contact Nos. Work/mobile : ............................   

Home.......................

Gender : ............ (man or lady)

--------Declaration : By signing the below I declare all the above----------------------------information is correct , I understand the tough nature of-----------------------------------this event and the limited first aid cover , I am an amateur --------------------------as defined by English Athletic rules and will abide by the---------------------------------relevant rules governing races of this nature , will follow-------------------------------any instructions given to me by officials of this event and------------------------------in no way hold the organisers , Liss Runners or the--------------------------------------Milland Sports Pavilion responsible for any loss , damage ,--------------------------------injury etc. resulting in my participation in this event.----------------

Signed :