Enter The Purbeck 10K 2019 The Purbeck 6.2m (10K) The Purbeck 6.2m (10K) Entry Form - 2019 Step 1 of 5 20% Name* First Last Gender*Please ChooseMaleFemaleAge on 15-09-2019*Date of birth* DD MM YYYY Email* Post Code* Street Address Address Line 2 City County / State / Region ZIP / Postal Code T Shirt not included in the entry fee.*Please ChooseI'd like to order a T shirt at £8 extraNo thanks.A T shirt is not included in the entry fee. If you would like to purchase below please select below.What size T-Shirt would you like?* Xtra Small Small Medium Large Xtra Large Are you a member of an affilliated club?*NoYesAffiliated clubUKA Affiliation NumberTeam name (opt)Your Phone Number*Emergency Contact Name* First Last Emergency Contact Phone Number*Where did you hear about The Purbeck 6.2? Runners World Website Our Website Other website Running magazine Other press Other Race Instructions and Terms and Conditions*Please confirm that you have read our Race Instructions and our Terms and Conditions of entry? http://thepurbeckrunningfestival.co.uk/ Yes Please confirm that you are aware that The Purbeck 6 (10k) is a bit more than 6 miles and is actually 6.36 miles (10.2K)* Yes Any additional comments or information you wish to pass on to the race organiserI DECLARE that on race day I will be fit to compete and over 15 years of age and will abide by the UK Athletics rules for competition. I accept that the organisers shall not be liable for any injury, illness or accidents as a consequence of my participation in this event. I will abide with the rules governing this event. I will carefully read all information sent to me prior to the event and I understand that this is a challenging, predominantly off-road event.* Please tick to confirm Purbeck 6.2 + Entry fee*Affiliated £16.00AffiliatedPurbeck 6 + Entry Fee*Unaffiliated £18.00Unaffiliated Entry FeePurbeck 6 + T Shirt Fee*T Shirt @ £8Not expecting to see this? You can use the 'Previous' button to go back and change your choice.ENTER DISCOUNT CODES HERE By using this form you agree with the storage and handling of your data by this website.* I Agree Admin fee £2 £ 2.00 This fee covers the costs and administration of online transactions.Total £ 0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Thank you for choosing to run The Purbeck 10k. You will shortly receive a confirmation email with further information. Good luck with your training and we'll see you on the 15th September 2019.NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.