TrailblazerTen 2019 - Entry Form
Race Date: 24th August 2019

Once you have submitted your entry form, please ensure that payment is made promptly via Bank Transfer to the following account:

Account Name: Fremington Trailblazers
Account Number: 54333868
Sort Code: 30-90-49
REFERENCE: Please use TEN, followed by the same name used on this entry form so that we can match your payment to your entry. (i.e. TEN Sam Smith)

Entry is £12 per person.
Affiliated runners: Are entitled to a £2 discount, providing you supply your ARC registration number on this entry form.

Please note that the race distances are approximate.

The email address provided in this section will receive the confirmation of your entry.

Email address *
Please specify which race distance you would like to enter: *
About You
First Name *
Your answer
Last Name *
Your answer
Age on Race Day *
24th August 2019
Your answer
If entrant is under the age of 18, please confirm that permission has been granted from parent/guardian
Gender *
Club ARC Registration Number (if applicable. MUST be supplied to be eligible for discounted race fee)
Your answer
Running Club Name (if applicable)
Your answer
Mobile Number *
Your answer
Email Address *
Your answer
Emergency Contact Details
Emergency Contact Name *
Your answer
Emergency Contact Mobile Number *
Your answer
Marketing Preferences
Please tick if you are happy to be contacted about future Fremington Trailblazer news & events via the following methods: *
Participants under the age of 14 must be accompanied by an adult at all times. Participation in the event is entirely at your own risk and by entering the event, participants acknowledge that we shall not be liable for death, injury, loss or damage arising from participation in the event, save to the extent that it is caused by our negligence. I understand that participating in this event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur 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 trail. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organisers, sponsors, promoters and each of their agents, representatives, successors and assigns, 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.
Please confirm that you have read, and agree to the disclaimer: *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service