Event Details and Entry Form
Welcome to this years Derwent River Relays and Fun Run!
Entries are now being taken, hope you can get a team or teams together and are able to join us for this marvellous event.
Check out the different categories that prizes are available for – perhaps you’ll be a winner this year?
Please click on the flyer image for details of the race and the entry form for entry details, this form can be downloaded, alternatively cut and paste the text below and email it through.
If you have any enquires please email us on derwentriverrelays@gmail.com Looking forward to seeing you on Saturday 7th July.
Come along and run and have some fun !!
Entry Form 2012 (pdf), Click to Open
Event Flyer 2012 (pdf), Click to Open
Cash prizes will awarded to these categories :
- First and Second Men’s Teams
- First and Second Ladies’ Teams
- First Mixed Team First Veteran Men’s Team (40+)
- First Veteran Ladies’ Team(35+)
- First Corporate or Community Men’s Team
- First Corporate or Community Ladies’ Team
- First Corporate or Community Mixed Team
- Fastest male and fastest female lap of the day
Entry Form 2012 Text (for email to derwentriverrelays@gmail.com)
Cut, Edit and Paste if emailing
The Derwent River Relays and Fun Run Entry Form Licence no.2012-104224
Team Names (4):
Team co-ordinater:
Please enter the following numbers of relay teams …
Men———— Veteran Men ————- Ladies ————- Veteran Ladies ————– Mixed—————–
Note: Lower age limit = 13. No runner shall run more than one leg for a team. Runners may run
legs for more than one team. Mixed teams shall not contain more than two men. All runners
in veteran teams must be of min. age 40 (men) and 35 (ladies). Teams to be declared and
race numbers issued on the day. England Athletics runner registration numbers will be
required on the day for all affiliated athletes declared.
Please enter the following number of entrants for the Fun Run …
Adults _________ Children__________
Total number of teams @ £16 each (In advance entries) £ _______
Total number of teams @ £20 each (On the day entries) £ _______
Total number of Fun Run pre-entries @ £2 each:
I enclose a cheque payable to BELPER HARRIERS for £
Please send to: Andrew Rose, 8 Redhill Court, Belper, Derbyshire, DE56 1QE enclosing a SAE (A5 size) for
confirmation, directions and further details or supply an email address for paperless reply.
Enquiries please to derwentriverrelays@gmail.com.
Closing date for entries Wednesday 4th July
Declaration: On behalf of the above team(s) and individuals, I understand that all competitors run at their own
risk. All must be medically fit and will not hold the organisers responsible for any injury or illness, nor loss or
damage to property, before, during or after the event. I declare that I will make all competitors in my club’s or
organisation’s team(s) aware of this. I hereby sign on their behalf…
Name: _________________________________________ Signature: ____________________________
Address: ______________________________________________________________________________________
_____________________________________________________________________ Date: ____________________
Phone:
E-mail:
Official use only:
Date received : Cheque Number: Details despatched:
