Leeds Country Way 2025 sign up form - Kippax & District Harriers

Club / Team Name *

If your Club is entering multiple teams please enter a name to easily identify the team. Example Kippax Harriers - Mixed 1

Your Name *

Team Captain

Full Address (including postcode) *

Email *

Team Category *

To qualify as Veterans Ladies in the team must be over 35 and the Men over 40

Phone Number

Mobile Phone *

Paragraph Text

Payment Confirmation *

Pease tick to confirm you have made payment by bank transfer

Entry is not guaranteed until payment has been made. Please make sure your club team name is referenced.) If you have any further questions please email Andy Hill at leedscountryway@kippaxharriers.org.uk

Declaration *

I confirm I have read and agree to the following declaration.

Please enter the above team for the Kippax Harriers Leeds Country Way Relay. I agree to abide by the rules made by the organisers and understand that no liability can be accepted by them for any injury sustained by me or any property lost by me during the period of this event. You agree that we may publish your Personal Information as part of the results of the Event and may pass such information to the governing body or any affiliated organisation for the purpose of insurance, licences or for publishing results either for the event alone or combined with or compared to other events. Results may include (but not be limited to) name, any club affiliation, race times, occupation and age category. You also confirm that your club is compliant with The General Data Protection Regulation (GDPR) and has permission to submit entrants' data in order to enter events such as this. By ticking this box, I confirm I have read and agree to the above declaration.