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Te Aroha 10km Run Sunday 4 March 2007

Instructions: Print this form, fill it in and mail with payment to:
K Diprose, PO Box 145, Te Aroha

• Please make cheques payable to: Te Aroha Athletic Club.
• Please enclose a SAE if you require confirmation of entry.
• Entries close 2nd March 2007 - Late entries $5.00 extra.
• All entrants must sign the declaration.

Your Details

Last Name:	__________________________
First Name:	__________________________
Address:	________________________________
	________________________________
Contact Phone:	__________________________
Club:	__________________________
Registration No:	___________

Category

please tick one ...   Walker     Runner

Event

please tick one ...   10km     5km

Grade

10km runners only please tick one ... 

	Men Under 20		Women Under 20
	Open Men		Open Women
	Masters Men 35-49		Masters Women 35-49
	Veteran Men 50+		Veteran Women 50+

Fees

10km	$15.00	_______
5km	$5.00	_______
Late entries (10km only) - add	$5.00	_______
TOTAL:		$_______

Declaration as an amateur

I declare I am eligible to compete under IAAF Rules. This signed declaration must accompany your entry form.

Signed:_______________________________________