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Rochdale 10k Road Race, Lancashire - Online Entry
Tuesday 1st July 2008 at 7.15pm

Please note that, after you click "Send it!" at the bottom of the page, you will go to a verification page. Once you are happy that your information is correct, you can submit your entry and move to the payment page. Sorry if this is a bit longwinded but it's necessary to ensure that your data is correct! In particular, please ensure that you include your correct age AS AT RACE DAY.

If you submit an online entry but then choose to pay by cheque (£5 attached, £7 unattached) payable to "Rochdale Harriers & AC", please indicate this on a clearly marked printed copy of this form attached to your cheque to avoid duplication, so we can delete your online entry details. If you want to collect your number on the night, no SAE required. The postal address is Phil Roberts, 19 Shepherd Street, Rochdale, Lancashire OL11 5SU A paper entry form can be downloaded - click here (acrobat .pdf).

There is a £1 handling charge for online entries BUT you don't have any stamps or envelopes to pay for and your race number will be available for collection on the day. Nochex and PayPal do not require information other than that which relates to your credit or debit card - no pesky registration requirements!

Starred items (*) must be completed (even if with "none")

Event entered * [Rochdale 10k Attached @ £6.00]
   [Rochdale 10k Unattached @ £8.00]

   Select according to whether or not you are a UKA club member
Forename* 
Surname* 
If you have a name like MacDonald please enter with a space before the next capital as Mac Donald - to ensure correct capitals.
House name and/or address*   e.g. 1 Smith Street
Second line of address     e.g. off Main Street
District     e.g. Smallville
Town*   e.g. Bigtown
County*  Postcode *
   If you are from an address outside the UK select "Outside UK" at the bottom of the list.
Telephone* 
Email address* 
Gender* 
Enter your age at 01/07/2008* 
Date of Birth - select from boxes* Day: Month: Year: (Your race category is based on age at 1st July 2008 - min. age 15 on race day)
UKA/ARC affiliated Club name
(or 'Unattached')		* 
(You MUST be a member of a UKA/ARC affiliated club to pay the lower rate - if you pay the wrong fee you will have to pay a further £2 at registration before you collect your number)
UKA/ARC Reg No (or 'none')*  If you know your UKA/ARC registration number enter it here otherwise leave as "none"
If you want to add specific information (e.g. medical problems), please do so here.
    

Disclaimer and agreement - Please enter me for the above event. I hereby declare that I am an amateur according to UK Athletics rules. I understand that I take part entirely at my own risk and accept that the organisers shall not be liable for any injury or illness to my person as a result of taking part, nor for damage to or loss of property.
Data Protection information - your details will be retained on computer by the organisers and UK Results only for the purposes of this event and any future events promoted by the club and will not be passed to anyone except for emergency services use, if appropriate.
I accept the above terms and conditions (please tick for online entry or sign if posting a completed form with cheque for the correct amount) *

Click "Send it!" to complete your entry and move to the verification page.

or "Clear details" if you need to delete your details and re-enter them.