Print off this form and send to address at bottom of the page

Ballymena Runners AC
ECOS  5
incorporating NIAF N Ireland 5 Mile Road Racing Championships
1st June 2005
Entry form

 Entry fees;

£5.00/ £6.00

Att/Unatt
Surname:   First Name:
  Date of Birth:   Age on Race Day:   Sex:
  First Claim Club:   NIAF Att: Yes/No
  Address:
  Town:
  County:   Postcode:
  Contact Telephone Number (Including Dialling Code):
 
e-mail address ;
  Declaration: I agree to bide by NIAF rules, and declare that I am entering this event entirely
  at my own risk and will not run on the day unless fit to do so.
  I enclose  a cheque (payable to Ballymena Runners) to the value of: £
  Signed:   Date:

Please forward this entry form to Stephen Armstrong, 39 Loughan Hill,

Ballymena, Co Antrim, BT43 5LR, tel; 028 2565 2712