*SURNAME:

* POSTAL
ADDRESS:

* FIRSTNAME:

* AGE ON RACE DAY:

* GENDER:

MALE FEMALE

* RUNNING CLUB:
(if attached)

* POSTCODE:

5 MILES

10 MILES

* PLEASE TICK AS APPROPRIATE

*TELEPHONE:

N.B., If you later decide to change the chosen distance run, please advise the late entry tent on arrival, as winners will only be declared on the length of race entered.

* To Mersea Island Lions Club: I am medically fit to run and accept that the organising club and its member will not be held liable for any loss, accident or injury before, during or resulting from the event. The organisers reserve the right to cancel the event without notice if necessary. Please tick box

Please now send appropriate entry fee (see amounts above) and first class 9" x 6" SAE (for information schedule/ race number) to:
Terry Walker 26 Garden Farm, West Mersea, Colchester, Essex, CO5 8ES
Tel. 01206 383640
E-mail. terryinmersea@live.co.uk
Cheques/ PO's to be made payable to Mersea Island Lions Club.
Closing date for pre-entries, 25th August 2011.