Undulator Entry FormYour DetailsFirst Name *Last Name *Age on 29th September 2024 *Gender *FemaleMaleClub Name0 / 180Email Address *Phone Number *AddressStreet Address *Town/City *County *Post Code *Emergency Contact DetailsEmergency Contact Name *Phone *AgreementWhen entering this event, participants must agree that their Personal Information may be published as part of the results of the Event for the event alone. Results will include name, any club affiliation, race time and age category. I consent to my name and all other data entered here being collected when I submit this form and stored for the purposes of managing the race. I declare that I am medically fit to run and that I enter the race entirely at my own risk. I understand that the organisers or sponsors will not be responsible for any injury or illness incurred before, during or as a result of the event, or for any property lost, stolen or damaged.Races Mailing ListPlease keep me informed of other races organised by Wirksworth Running Club (WRC).WRC will only use your contact details for the purpose of keeping you informed of races that it organises. WRC will not share your details with any Third Party.Where did you hear about this race?Not answeredFacebookTwitterGoogle searchWirksworth RC siteFRA siteOther website (please specify)FlyerWord of mouthOther (please specify)Please let us know where you heard about this race.Other0 / 180PaymentCredit / Debit Card *Submit EntryPlease do not fill in this field.