Undulator Entry FormYour DetailsFirst Name *Last Name *Date of Birth *DaySelect day12345678910111213141516171819202122232425262728293031MonthSelect month123456789101112YearSelect Year212621252124212321222121212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926Age on day of race *Gender *FemaleMaleVehicle RegistrationClub Name0 / 180Email Address *Phone Number *AddressStreet Address *Town/City *County *Post Code *Emergency Contact DetailsEmergency Contact Name *Phone *AgreementBy completing this form and entering the race you are agreeing to the following: *I accept the hazards inherent in fell running and acknowledge that I am entering and running this race at my own risk.I confirm that I am aware of the rules imposed on me by the Race Organiser and that I will comply with them.I confirm that I have read, and will comply with, the “FRA Requirements for Runners” and especially the “absolute no-nos” of fell running.I confirm that I am aware that the race is a fell race (not a trail race) run under FRA licence.I acknowledge and agree that I am responsible for determining whether I have the skills equipment and fitness to participate in this event.I accept that neither the Race Organiser nor the Fell Runners Association shall be liable to me for any injury, loss or damage of any nature to me or my property arising out of my participation in this race (other than in respect of death or personal injury as a result of their negligence).I consent to publication of my name, club, race category, race number, finishing time and race position in race pre-entry and results lists, and to the sharing of all the above details with trusted partner organisations (e.g. UK Athletics) for disciplinary purposes or otherwise where necessary in the interests of the sport.I accept that the Race Organiser may use photographic or video equipment for the purpose of monitoring the race.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?Please let us know where you heard about this race.Other0 / 180Payment£10.00Credit / Debit Card *Submit EntryPlease do not fill in this field.
