British Schools Cycling Association

BRITISH SCHOOLS CYCLING ASSOCIATION

OFFICIAL ENTRY FORM

Event title:
Date:
Venue:
Time:
Closing date:
Promoters name:
Promoters address: Telephone number:
E-mail:
Race categories:
Entry fees:
Cheques payable to: / 2009 Welsh Schools Cyclo-Cross Championships
Saturday 10th October 2009
Penlan Sports Fields, Brecon, LD3 9RS
First race starts at 1.00pm
Friday 2nd October 2009
Clive Powell
Cwmdauddwr Arms, West Street, Rhayader, Powys, LD6 5AB
01597 811343

Yr 3 & below/Yr 4 & 5/Yr 6 & 7/Yr 8 & 9/Yr 10 & 11/Yr 12+
Yr 7 & below £2.00/Yr 8 & above £4.00
Clive Powell

PLEASE PRINT CLEARLY IN BLOCK CAPITALS:

Please enter me for: 2009 Welsh Schools Cyclo-Cross Championships

Full Name: ……………………………………………………………………………………………………………………….. Boy/Girl

BSCA Membership Number (not BCF or WCU) ………………………… (£1 surcharge if not a BSCA member)

Address: ……………………………………………………………………………………………………………………………………………

………………………………………………………………………………………… Postcode: ………………………………

Telephone Number: ………………………………………… E-mail: ………………………………………………………………..

Date of Birth: …………………………………………………. School Year: ……………………………………………………….

School Name: ………………………………………………………………………………………………………………………………….

ALL COMPETITORS IN BSCA EVENTS RIDE IN THE NAME OF THEIR SCHOOL

I hereby declare that the particulars submitted on this entry form are complete and correct. I agree to abide by the rules of the BRITISH SCHOOLS CYCLING ASSOCIATION and to accept the decisions of their Officials in all matters concerning this event.

Signed: ………………………………………………………………………………… (Competitor)

Entry fee enclosed (Yr 7 & below £2/Yr 8 & above £4 plus £1 surcharge if not a BSCA member): £ ……………..

PLEASE MAKE CHEQUES PAYABLE TO CLIVE POWELL AND SEND TO CLIVE POWELL, CWMDAUDDWR ARMS, WEST STREET, RHAYADER, POWYS, LD6 5AB BY FRIDAY 2ND OCTOBER

TO BE SIGNED BY PARENT/LEGAL GUARDIAN

I, being the Parent/Legal Guardian of the entrant named on this form, hereby agree to his/her participation in the competition under the terms and conditions stipulated.

Signed: …………………………………………………………………………………………… Date: ………………………………..

BSCA records are being updated onto computer.

Members not wishing their details to be stored on computer should contact the General Secretary.