Suffolk Back Yard Ultra

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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 2021 2020 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    Gender -- Male Female   Phone #   Address   Emergency contact name   Emergency phone #   City   Zip code / Postal code   State / Province   Country   Event entry fee increases after November 30, 2021 Event entry fee 83.33 GBP

T-shirt size  * Choose one XSmall (Ladies only) Small Medium Large Extra large   Do you require a minibus/transport from Diss station on Saturday morning? No thanks I have my own transport. Yes please, Saturday Morning 09:45 0.00 GBP 10.00 GBP Any medical Issues/conditions that would affect any first aid given by race staff or emergency services or may affect your participation in the race  *   Please tick to confirm you give permission for us to use your data in line with GDPR and our Data policy (Policy on website). If you do not consent we must refund and cancel your entry.  * NoYes

Discount or coupon code   Subtotal 83.33 GBP Discount 0.00 GBP Processing fee 4.17 GBP VAT 17.50 GBP Total 105.00 GBP Calculate

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver LIABILITY WAIVER I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and have properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am traveling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organisers, Challenge Running, sponsors and all other persons associated with the event, for all my liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by the action or inaction of any of the above parties. I hereby grant full permission to any and all of the above parties to use any photographs, video, website images, recordings or any other record of this event. I accept the terms of the waiver