British Masters` Athletic Federation

Outdoor Pentathlon

Sunday 23^rd May 2010

(Under UKA/IAAF/WMA Rules)

Horspath Stadium, Horspath Road, Oxford, OX4 2RR

(Male) (Female) Please tick

Name:___________________________________________________

Date of Birth:_____________________________________________

Age Group:_____________Age at Date of Competition___________

Address:_________________________________________________

_________________________________________________________

Tel. No.________________Email:_____________________________

BMAF Affiliated Club:_________________________Country Reg. No.____________

Non Affiliated Club:__________________________ Country Reg. No.___________

Fees:

Affiliated £15.00 Non Affiliated or Overseas entry £18.00

I enclose my entry fee (Affiliated) £

(Non affiliated) £

I hereby agree that the organisers shall not be liable for any accident, injury, loss or damage as a consequence of my participation in this event.

Signature:______________________________ Date_____________

NOTES

1) Entry fees to: Bruce Charles, 77 Oxford Cres. Didcot, OX11 7AL

2) Cheques to be made payable to BMAF

3) Evidence of Age for non affiliated athletes is required.

4) Please enclose a stamped addressed envelope for acknowledgement of entry and directions . These will be sent out ASAP after 8/5/10

5) ENTRIES CLOSE SATURDAY 8^th May 2010