Your Name (required)

Club / Team name (required)

Team Captain

Full Address including postcode: (required)

Email Address (required)

Team Category - Please indicate which team category this entry is for. To qualify as Veterans Ladies in the team must be over 35 and the Men over 40 (required)
OpenLadiesVetsTo Be Confirmed

Evening Phone:

Mobile Phone: (required)

Cost of entry is £132 per team. (£11 per runner) and each competitor will receive a commemorative piece of pottery.

Closing date for entries is Monday 14th August or until the race is full, whichever comes first.

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.

By ticking this box, I confirm I have read and agree to the above declaration.

Payment Method
Bank Transfer (please see bank details below and make sure, your club team name is referenced.)Cheque - Please make cheques payable to Kippax Harriers and send to: Helen Cowley LCW Race Secretary 162 Austhorpe Road Crossgates Leeds LS15 8EFPayPal - After submitting the entry form, please follow the PayPal link below to submit payment. Please note there is an additional £5 charge for using Paypal to cover PayPal charges so total cost of entry will be £137 per team.

If you have any further questions, please telephone Helen Cowley - 07905 328 722 or email info@kippaxharriers.org.uk