2011 Roller Racing Entry Form

Name:

Address:
Postcode:  Telephone: 
Club:
Email:
 
Please enter me for the Mildenhall Rally Roller competition on 28/8/11.
I understand that I enter entirely at my own risk and I accept that the organisers will not be liable for any loss, damage, action, claims, costs or expenses which may arise in consequence of my participation in this event.
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Signed
Date
 
 
Date
  (Signature of parent or guardian - IF UNDER 16)

Please make cheques payable to Maldon & District CC enclosing an SAE and send to 72 Nipsells Chase, Mayland, Chelmsford. CM3 6EJ.