Canicross Anglesey Newborough 2022 Race weekend

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Entry form

Runner Name *

Address *

Email *

Telephone number *

Gender *

Male

Female

Category (based on age on the day) *

Open (15-39)

40-49

50+

2 Dog (Adults only)

Junior (11-14)

Cub (7-10)

Mini Cub (Under 7)

Races entered (Sat 5km and Sun 10Km combined for prize giving). *

Saturday 5Km

Sunday 10Km

Sunday 5Km

Sat Short (all runners under 15)

Sunday Short (all runners under 15)

Required

Estimated 5Km time *

Emergency contact details (name and phone number) *

I agree to follow Canicross Anglesey terms and conditions regarding the race entry and follow Canicross Anglesey race rules during the races. *

I Agree

Payment

Payment can be made via bank transfer or Cheque.

For 1 race the total cost is £17
For 2 races the total cost is £30
For 3 races the total cost is £35
Short course is £10 per day.

Bank details are:
Lloyds Bank
Account name: Canicross Anglesey
Account Number: 46466960
Sort Code: 30-90-43
Please use the runners name as the reference.

Cheques
Please make cheques payable to 'Canicross Anglesey'
Post to
Canicross Anglesey
Bodgwilym
Lon Groes
Anglesey
LL60 6DF

Payment made by *

Bank Transfer

Cheque

Signed (please type name) / Parents Signature for under 18 year olds *

Submit

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