Exterminator

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Team name   First name   Last name   Email address   Date of birth DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    MM 01 02 03 04 05 06 07 08 09 10 11 12       YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920    Gender -- Male Female   Club name Choose one Totley AC Barnsley Harriers Beeston AC Buxton AC Clowne Road Runners Danum Harriers Dark Peak FR Fat Boys RC Hallamshire Harriers Handsworth Roadhogs Holmes Pierrepont RC Long Eaton RC Matlock AC North Derbyshire RC Penistone Footpath Runners Porter Valley Plodders Rotherham Harriers Sheffield RC Shelton Striders ShUOC Smiley Paces Steel City Striders Vegan Runners Worksop Harriers Other     Phone #   Address   Emergency contact name   Emergency phone #   City   Post code   Category Choose one M40 M50 M60 M70 MSen UM23 UW23 W40 W50 W60 W70 WSen   Event entry fee 9.00 GBP

Vehicle Registration Enter Race Series? NoYes 5.00 GBP

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver I accept the hazards inherent in fell running and acknowledge that I am entering and running this race at my own risk. I confirm that I am aware of the rules imposed on me by the Race Organiser and that I will comply with them. I confirm that I have read and will comply with the FRA 'Requirements for Runners'. I acknowledge and agree that I am responsible for determining whether I have the skills, equipment and fitness to participate in this event. I accept that neither the Race Organiser nor the Fell Runners Association shall be liable to me for any injury, loss or damage of any nature to me or my property arising out of my participation in this race (other than in respect of death or personal injury as a result of their negligence). I consent to the publication of my name, club, race category, race number, finishing time and race position in race pre-entry and results lists. I consent to the personal information entered on this form being used for the purposes of organising this race, and for the information to be processed and stored in the USA. I accept the terms of the waiver