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Name:
Address:
Post Code:
Home Tel: Work Tel:
Mobile Tel: E-Mail:
Date Of Birth: Club:

Male
Female
Membership Category:
Free Vest or T-Shirt
Size

Athletes: Please Give Details
Distance Time Date Venue
400m
800m
1500m
3000m

Your Coach's Name
Your Coach's Tel No

This form should be printed. Then return the completed application form and cheque to:
BMC Treasurer, Pat Fitzgerald, 47 Station Road, UXBRIDGE, UB8 3AB
Please enclose an A4 stamped self addressed envelope and a cheque for 30 (35 overseas).
Cheques should be made payable to BMC