Name of Competitor/Team members name and Team name (First name & Surname)
Contact Address inc post code
Home telephone No.
Fax No or email Address
Age (under 16’s need signed adult letter of consent)
Male/Female
T shirt Size (M.L.)
Medical Conditions (please note any condition of which you think we should be aware)
Emergency Contact Name/No
Individual’s Entry Fee £15.00
Team Entry Fee £24
Please make cheque payable to: Charlestown Regatta Committee
Disclaimer
I declare that I will abide by the rules of Charlestown Regatta Committee and accept that the event organisers and their associates are not liable for any loss, damage, claim or expense which may arise as a consequence of my participation in this event. I will cycle with care and attention and abide by the normal rules of the road. I am in good health and compete at my own risk. It is the competitor’s/Team’s responsibility to know and correctly complete the full course of the event. Organisers suggest personal accident insurance cover during this event.
Date Signed
No Entry on the day. Last entry to be received strictly by 30th July
