Llangollen Round Challenge - 2nd & 3rd June 2018

Entry Form (One for each entrant)

You will receive confirmation of entry, accommodation details, route booklet with amendments, full details, rules, and sponsor forms. 

Please note that entry will close when the event is full.

If you would like more information at anytime please phone on mobile 07905 330788 or e-mail thellangollenround@gmail.com

The event organiser will only use your details to communicate with you about the Llangollen Round Challenge.

PLEASE NOTE: ENTRY FEE FOR EITHER 1 OR 2 DAY EVENT
IS £25/PERSON OR £60/FAMILY
NOTE: Family Ticket = Parents + 1-2 Children (15-17yrs old). Please fill out an entry form for each member of the family
YOU WILL BE TAKEN TO PAYPAL IN ORDER TO MAKE PAYMENT ONCE YOU HAVE FILLED OUT THIS FORM
(Click here if you want to fill out our offline form and pay via cheque)
Name (as to appear on certificate)
Age on day of walk Must be 15 years or over
Gender Male Female
Car Registration
Address
Postcode
Email
Tel No (landline)
Mobile (if carried on walk)
Emergency Name and Tel
Medical Conditions - Any medical condition/information that may be relevant in case of accident (will be in strict confidence). If you are unsure of your physical ability to take part in the event please take medical advice from a General Practitioner prior to the event.
Where did you see the walk advertised?
I would like to enter 1 day 2 day

Family entry (1 booklet) for the 2-day event  £60.  A separate form should be filled in for each member.

I understand that I take part in the Llangollen Round Challenge at my own risk and that neither the Llangollen Committee nor Cancer Research UK will be liable for any injury, damage or loss that may occur as a result of my participation other than in respect of death or personal injury arising as a result of their negligence. I agree to abide by the CRUK event rules and observe the Countryside Code at all times. I confirm that I have sufficient knowledge, experience, equipment and navigational skills to participate in a long-distance walk in all conditions.   I understand that medical advice should be sought from a General Practitioner if I am in doubt as to my physical ability to participate in the event.  I consent that photographs taken during the Llangollen Round Challenge event may be used to publicise events and Cancer Research UK in all media.

Subject:


Counter Signature required by Parent or legal Guardian (If  entrant is under the age of 18). I agree to the participation of the above named person in the Llangollen Round Challenge. He / she will be accompanied by me at all times.

Counter Signatory Name