WICKLOW WAY RELAY Entry Form

Team Name: _____________________________
Team Leader: _____________________________
Address: ____________________________________
Phone(s): _______________________________
E-Mail: _______________________________

Team Members

 

Name

Cat.*

Date of Birth

Stage(s)

1.

        

2.

        

3.

        

4.

        

5.

        

6.

        

7.

        

8.

        

Fee €15 per team member. Total: ________

I have read the rules of the competition and agree to uphold them.

__________________
Team Leader


Return by post to IMRA
6 Knocksinna Grove
Dublin 18 (with appropriate fee)

* MJ/FJ/M/F/M40/F40/M50/F50