THE ANOYIRA TEN
              10   APRIL 2005

               REGISTRATION FORM
 

To Register for the Anoyira Road Run,please fill the following form and submit it.

Otherwise print out the Entry Form and sent it to the organisers,either by e-mail(johnron2@cytanet.com.cy)  or by fax it  to 25222631or post it to

John Lawton,4603  Anoyira,  Limassol, Cyprus

 

All registrations will be confirmed by e-mail if received on or before 2nd of April 2005.    No registration transfer is allowed whatever the reasons.

All entries should be received by Saturday 2nd April 2005. Late entries (those received after 2nd April) may also accommodate a surcharge of  CYŁ5 handling fee.

 

 

  

RACE NAME:
   

Surname:

Name:

Sex:

Date of Birth:(dd/mm/year)

Club or Team(Exact Name)

Address:

Postal-code:

City:

Country:

Nationality:

Phone:

E-mail:

T-Shirt:
 

ENTRY  FEES:

Cost of Entry: CYP 5.00.

Cost of Entry on the day will be CYP 10.

 

Entrants should pay by Visa or MasterCard

 
   

VISA-CARD:

Card Number:
   

PAYMENT:

 CYŁ        
EXPIRATION  DATE: MONTH :

YEAR:     

Cardholder name:
DECLARATION:

 I  declare that I will abide by rules and I accept that the organizers will not be liable for any loss, damage, action, claim, costs or expenses which may arise in consequence of my participation in this event.

 I declare that I will not compete in this race unless I will be in good health on the day of the race and that, in any event, I will only compete at my own risk. The organizers of the race have the right to refuse entry, and the decision of their officials will be final. I authorise the organizers to use any details or photographs for publicity purposes,if they wish so.

 I  hearby signify that I have read and agree to the terms of the above declaration.

(Parent´s signature if under the age of 18)

 

  Name: