Name (include Mr, Mrs, Miss, Other etc)

Address: Town: Postcode:

Telephone: Mobile: Email:

Chosen Distance
Please select distance 12 Mile Walk 6 Mile Walk Golden Mile

How many in your team?
Just me! 2 walkers3 walkers4 walkers5 walkers6 walkers7 walkers8 walkers9 walkers10 walkers11 walkers12 walkers13 walkers14 walkers15 walkers16 walkers17 walkers18 walkers19 walkers20 walkers21 walkers22 walkers23 walkers24 walkers25 walkers26 walkers27 walkers28 walkers29 walkers30 walkers31 walkers32 walkers33 walkers34 walkers35 walkers36 walkers37 walkers38 walkers39 walkers40 walkers41 walkers42 walkers43 walkers44 walkers45 walkers46 walkers47 walkers48 walkers49 walkers50 walkers51 walkers52 walkers53 walkers54 walkers55 walkers56 walkers57 walkers58 walkers59 walkers60 walkers61 walkers62 walkers63 walkers64 walkers65 walkers66 walkers67 walkers68 walkers69 walkers70 walkers71 walkers72 walkers73 walkers74 walkers75 walkers76 walkers77 walkers78 walkers79 walkers80 walkers81 walkers82 walkers83 walkers84 walkers85 walkers86 walkers87 walkers88 walkers89 walkers90 walkers91 walkers92 walkers93 walkers94 walkers95 walkers96 walkers97 walkers98 walkers99 walkers100 walkers

T Shirt order (Optional)	S	M	L	XL
T-shirts cost £8 each and can be collected on the day.

The total entry fee covers all the people and t-shirts listed above. In applying to take part, I and the other people listed are aware of the rules and conditions set out and agree to abide by them.

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