Burton 10 Mile & Fun Run Entry
First Name  
Surname  
Email    
Telephone  
Address  
Town - City  
County - State  
Post - Zip Code  
Date Of Birth ( dd/mm/yyyy) 
Gender
Club (Affiliation)
UKA Affiliation No.
Race Entry
Comments (optional)

By clicking continue below you are declaring that to the best of your knowledge you are medically fit to compete. You enter at my own risk and agree that the organisers shall not be liable for any accident, injury, loss or damage resulting from my participation. You also agree to abide by the UKA rules.