Licence No: 2018-33543

ENTRY FORM

MIDLAND U13/15/17 5km Championship

Sutton Park, Sutton Coldfield

Saturday 17th March 2018

Start Times:U13 11.00am, U15 11.15am, U17 11.30am

Closing Date: Sunday25thFebruary 2018

Midland Medalsto the first 3 Midland eligible individuals in each age group

The Championship Challenge Plaque to first individual in each age group (Male/Female)

Midland Medals to first three teams (3 to Score)

The Midland Counties are:

Avon, Herefordshire, Gloucestershire, Leicestershire, Northamptonshire, Nottinghamshire, Shropshire, Staffordshire, Warwickshire, Worcestershire

Midland Eligibility – All competitors must have one of the following qualifications

  • The athlete having been born in the Midland Counties (as above).
  • A minimum of 9 months continuous residence in the Midlands immediately prior to the event.

Members of The South West Region of England Athletics, Derbyshire and Lincolnshire may also enter this event in 2018. Any Individual from these areas finishing in the top three overall will be awarded EA Tri-Regionmedals only. You may only compete in one Area Championship in any 12 months.

Entry Fee: £5.00 per Individual. Please tick method of payment Entry Fee Enclosed

  • Cheque payable to ‘MCAA’
  • BACS to Lloyds TSB a/c 01685720 Sort Code 30 00 06 £

(Please use Ref code R5km2018 plus Club Name)

  • Enter online at:

QR Code

I hereby declare that:

IMPORTANT: All entered athletes must have a currently registered and paid up England Athletics (EA) number. Without a valid EA number the entry CANNOT be accepted.

For this competition, the information required is Name, Date of Birth, EA number and

Midland Qualification either B – Birth, R – Residence. (qualification not required for open race)

NB: The organisers reserve the right to refuse entries and revise dates where necessary.

I hereby agree that all the entrants are eligible to compete according to the laws of UK Athletics. They are also eligible to represent the club under UKA rules and that the declared particulars are complete and correct.

Signed: Printed Name:Date:

Address:

Tel No: Email:

The organisers reserve the right to refuse entries and revise dates when necessary.

Please return to:MCAA, Alexander Stadium, Walsall Road, Perry Barr, Birmingham, B42 2LR.

Email:

MIDLAND 5km CHAMPIONSHIP CHALLENGE

2018ENTRY FORM for U13/15/17 BOYS/GIRLS

Name of Club:Age Group:

Club Colours (Which MUST BE WORN):

Please complete the list below OR attach a Club generated list (e.g. from the EA database or a spreadsheet)

of your entrants in the format below which contains all the entry data requested.

Competitors Please enter
ALPAHABETICALLY IN BLOCK CAPITALS
by Surname / Date of Birth / EA Number / Midland
Qualification
FORENAME / SURNAME
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24

Postal entries please enclose appropriate S.A.E. for details if no Email address supplied.

Please note:

For Midland qualifications please enter:B – Birth – R Residence –

RULE 141 S3 (i) Under 13 boy’s road running competitions shall be confined to competitors who are aged 11 on the day of competition or 12 on 31st August prior to the commencement of the competition year

RULE 141 S3 (ii) Under 15 Boys and Girls: road running competitions for under 15s shall be confined to competitors who are aged 13 or 14 on 31st August prior to the commencement of the current competition year.

RULE 141 S3 (iii) Under 17 men and Women:Road running competitions for under 17s shall be confined to competitors who are aged 15 or 16 on 31st August prior to the commencement of the current competition year.