Purbeck 16 Registration Form Please read this form carefully. Purbeck 16 Registration For entries into The Purbeck 16 Step 1 of 5 20% EmailThis field is for validation purposes and should be left unchanged.Declarations and AgreementsWe have made this form very simple. To see the full information to which you are agreeing or declaring please go to our Declarations and Agreements page. By selecting the checkbox below I confirm that I have read and agree to the following:- Purbeck 16 Fitness Declaration Purbeck 16 Photography Release Purbeck 16Terms and Conditions of Entry The Purbeck 16 Declarations and Agreements(Required) I agree and confirm Contact DetailsName(Required) First Last Email(Required) Enter Email Confirm Email Phone(Required)Date of Birth(Required) DD slash MM slash YYYY Are you a Member of a running club?Club Name Emergency Contact DetailsName(Required) First Last Phone(Required)Relationship(Required)WifeHusbandParentFriendOther Event DetailsGender(Required)MaleFemaleRace Category / Age(Required)Select your race categoryOpen / 18 - 39Masters / 40 - 59Veterans / 60 +Anticipated Race Time(Required)How long are you expecting it to take you to complete?Please Select2-3hrs3-4hrs4-5hrs5-7hrs6-7hrsHow did you hear about this event?FacebookInstagramOther Social MediaPrinted Advert/FlyerWord of MouthPast ParticipantOtherAre you running for a charity or good cause?Let us know about the charity and your target.Affiliation MembershipAre you a member of the Trail Runners Association or UK Athletics? Please select below.Please SelectNOYES Payment DetailsEntry TypeRegular Price: Affiliation FeesTRA or UKA None Affiliated Fee £2.00 Price: FeesPayment Processing Fee £2.50 Price: Total Credit Card
