UK Athletics, England Athletics and the Race Walking Association

jointly present the 2012 National 10mile Race Walking Championships

to be held under IAAF rulesSunday 4th March at the University Business Park, Coventry

starting at 1.30pmEntry Fee £10.00 to Peter Marlow Tel: 01284 754177

The Picture House, 134G Southgate Street, Bury St Edmunds, Suffolk. IP33 2AF

Cheques made payable to the Race Walking Association.Closing date for entries Monday 27th February

Changing and registration at Westwood Track, Coventry Godiva Clubhouse

Kirby Corner Road, Canley, Coventry, CV4 8EE

Please enter me for the following UKA Championship event to be held at University Business Park, Coventry, Sunday March 4th 2012.

Event _____________________________________________________________________

Name _______________________________________ Gender ____________________

Date of Birth ______/_______/_________

Address _________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Club____________________________________________________________________

County__________________________________________________________________

email:__________________________________________________________________

Telephone:_______________________________________________________________

Disclaimer: I acknowledge that the United Kingdom Athletics cannot be held responsible for any injury or loss sustained as a result of my participation in the event.

Signed ____________________________________________

Date ____________________________________________