Race Calendar

Willow Valley Flyer 2023

About You

First Name:

Last Name:

Date Of Birth:

Gender:

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Contact Details

Contact Telephone:

Email:

Address Line 1:

Address Line 2:

City:

Postcode:

Entry Details

Entry Type:

Affiliated Club:

Registration Number:

This club name has not been recognised. Only proceed if you are sure the name is correct and that your club is affiliated to your sport’s governing body.

Contact in case of emergency:

Phone in case of emergency:

We would like to print your name on the Willow Valley Tees. We will use your first name as entered above, but if you prefer to use a nickname then please add that below:

Additional Information:

Team Mate

First Name:

Last Name:

Date Of Birth:

Gender:

Charitable Donations

Brighouse Bumble Bees is fundraising for Overgate Hospice. If you would like to make an additional donation to Overgate Hospice, please enter an amount next to the chosen charity.

Donation to Overgate Hospice:

Please treat my donation(s) as a Gift Aid donation.

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for the current tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities and Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for the current tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I have given.

About Entrant _1

First Name:

Last Name:

Date Of Birth:

Gender:

T-Shirt size:

Contact Details

Contact Telephone:

Email:

Address Line 1:

Address Line 2:

City:

Postcode:

Entry Details

Entry Type:

Affiliated Club:

Registration Number:

This club name has not been recognised. Only proceed if you are sure the name is correct and that your club is affiliated to your sport’s governing body.

Contact in case of emergency:

Phone in case of emergency:

We would like to print your name on the Willow Valley Tees. We will use your first name as entered above, but if you prefer to use a nickname then please add that below:

Additional Information:

Team Mate

First Name:

Last Name:

Date Of Birth:

Gender: