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Cheviots Challenge
Entry Form
ALWAYS FOLLOW THE
COUNTRY CODE.
Cheviots Challenge Entry Form.
Web Site Entry Form Official Use Only.
Entry Number.
Please read our
ENTRY DETAILS
before completion.
CHEVIOTS CHALLENGE 2012.
Saturday 25
th
August 2012.
CLOSING DATE 11
th
AUGUST 2012
All entries must be accompanied by an ENTRY FEE of £15.00 and must include a
stamped addressed envelope
for a receipt, number and kit list. Please complete, download and send to the address below. Photo copies are acceptable. Once your application has been precessed, you will receive your entry number and a kit list.
Full Name
Age
(if under 18 years)
Emergency Address if different.
Address Line 1
Address Line 1
Address Line 2
Address Line 2
Address Line 3
Address Line 3
Post Code
Post Code
Tel. Nos. (inc STD Code)
Emergency Tel. Nos. (inc STD Code)
Mobile
Emergency Mobile
Registration of car in which you are travelling:
Do you have any medical conditions that we should know about?
Continue on back if necessary.
Please indicate your route choice by placing a tick in the appropriate box.
The Terry Lynn Long Route:
will include:
Cushat Law,
Bloodybush Edge,
Kings Seat,
Windy Gyle,
Clennell Street
and
Alwinton.
Eileen Lynn Short Route:
will include:
Cushat Law,
Bloodybush Edge,
Hazely Law,
Clennell Street,
and
Alwinton.
These routes may change on advice from the Northumberland National Park Senior Ranger
I wish to enter the Cheviots Challenge. I have read and agree to abide by the rules, contained in the
entry details.
. I understand that the organisers accept no responsibility in the case of injury or accident. I enclose a
SAE
and cheque/postal order payable to:-
"Cheviots Challenge "
for
£15.00
. Extra payment required for a T-shirt(s). Click
here
to order a T-Shirt.
Download a sponsorship form
Signed
Dated
Please send
entry
and
SAE
to:
Cheviots Challenge, 25 Hauxley Drive, Northburn Dale, Cramlington, Northumberland, NE23 3UZ. England.
Click
print
when completed. Alternatively, click
or
to download a blank application form. Click
here
to download a free copy of Adobe Reader.
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