NEMAA TRACK 5/10k CHAMPIONSHIPS
SATURDAY SEPTEMBER 16th 2017, MONKTON STADIUM
All 5-year age groups, male and female
11.00 W35+, M65+
14.00 M50, M55, M60
15.00 M35, M40, M45
NEMAA ONLY ENTRY FORM
FIRST NAME..........................................................................SURNAME..................................................................................................
ADDRESS...................................................................................................................................................................................................
POSTCODE............................................... TEL. NO........................................................................................................................
EMAIL..........................................................................................................................................................................................................
DATE OF BIRTH.................................................................... AGE ON SEPT 16th........................................ M/F ...............................
CLUB...............................................................................................................................5k (tick)................. 10k (tick)............................
UK ATHLETICS AFFILIATION NUMBER..............................................................
I AM A PAID-UP MEMBER OF NEMAA YES/NO................... NEMAA NUMBER .....................................
ENTRY FEE £4.00 (Cheques payable to NEMAA) £...........................................(enclosed)
ENTRIES TO: RON STEWART, 5 MAST LANE, CULLERCOATS, NORTH SHIELDS, NE30 3DF
ENTRIES CLOSE ON SEPTEMBER 9th 2017 STRICTLY NO LATE ENTRIES
SATURDAY SEPTEMBER 16th 2017, MONKTON STADIUM
All 5-year age groups, male and female
11.00 W35+, M65+
14.00 M50, M55, M60
15.00 M35, M40, M45
NEMAA ONLY ENTRY FORM
FIRST NAME..........................................................................SURNAME..................................................................................................
ADDRESS...................................................................................................................................................................................................
POSTCODE............................................... TEL. NO........................................................................................................................
EMAIL..........................................................................................................................................................................................................
DATE OF BIRTH.................................................................... AGE ON SEPT 16th........................................ M/F ...............................
CLUB...............................................................................................................................5k (tick)................. 10k (tick)............................
UK ATHLETICS AFFILIATION NUMBER..............................................................
I AM A PAID-UP MEMBER OF NEMAA YES/NO................... NEMAA NUMBER .....................................
ENTRY FEE £4.00 (Cheques payable to NEMAA) £...........................................(enclosed)
ENTRIES TO: RON STEWART, 5 MAST LANE, CULLERCOATS, NORTH SHIELDS, NE30 3DF
ENTRIES CLOSE ON SEPTEMBER 9th 2017 STRICTLY NO LATE ENTRIES
