NESQUIK 1.5KM MALTA MARATHON FUN RUN A FAMILY FUN RUN & WALK OFFICIAL ENTRY FORM SUNDAY 22 nd February 2015 PLEASE FILL IN BLOCK LETTERS BELOW: SURNAME : NAME : SEX: Male (M) / Female (F) ADDRESS : POST CODE: TELEPHONE: DATE OF BIRTH NAME OF SCHOOL TOWN / VILLAGE NAME OF CLUB IF ANY ENTRY FEE €4 ___This is the entry fee for the fun run and not a donation to Inspire. I enclose with this application form: cheque No. _____________, postal order No.____________________, cash €_________ being the amount of entry fee, including / excluding transport. Cheques / postal orders should be made payable to Pembroke Athleta Athletics & Triathlon I declare that I will abide by the eligibility rules. I also declare that I am physically fit and I will not hold the organizers responsible for any injuries or accidents sustained during the race. ____________________ _____________________________ ___________ Signature of Participant Signature of Parent (if participant is U/18) Date Entries and fees are to be sent to: Mr. V. Camilleri: 80 Mirammiti, Triq Sghajtar, Naxxar NXR 3312 – Tel: 21 433452 Questions??? Mob. 99255595 or Tony Fava (evenings only) Tel: 21388093 or 79271681 Closing date: Wednesday 18 th February 2015 (Photocopies of this application form will be accepted)
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NESQUIK 1.5KM MALTA MARATHON FUN RUN
A FAMILY FUN RUN & WALK
OFFICIAL ENTRY FORM
SUNDAY 22nd February 2015
PLEASE FILL IN BLOCK LETTERS BELOW: SURNAME : NAME : SEX: Male (M) / Female (F) ADDRESS :
POST CODE: TELEPHONE: DATE OF BIRTH NAME OF SCHOOL TOWN / VILLAGE NAME OF CLUB IF ANY ENTRY FEE €4 ___This is the entry fee for the fun run and not a donation to Inspire.
I enclose with this application form: cheque No. _____________, postal order No.____________________, cash €_________ being the amount of entry fee, including / excluding transport. Cheques / postal orders should be made payable to Pembroke Athleta Athletics & Triathlon I declare that I will abide by the eligibility rules. I also declare that I am physically fit and I will not hold the organizers responsible for any injuries or accidents sustained during the race. ____________________ _____________________________ ___________ Signature of Participant Signature of Parent (if participant is U/18) Date Entries and fees are to be sent to: Mr. V. Camilleri: 80 Mirammiti, Triq Sghajtar, Naxxar NXR 3312 – Tel: 21 433452 Questions??? Mob. 99255595 or Tony Fava (evenings only) Tel: 21388093 or 79271681
Closing date: Wednesday 18th February 2015 (Photocopies of this application form will be accepted)
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