Enter The Purbeck 5K 2019 The Purbeck 5K The Purbeck 5K Entry Form - 2019 Step 1 of 5 20% Name* First Last Gender*Please ChooseMaleFemaleAge on 16-09-2018*Date of birth* DD MM YYYY Email* Post Code* ZIP / Postal Code T Shirt not included in the entry fee.*Please ChooseI'd like to order a T shirt at £5 extraNo thanks.A T shirt is not included in the entry fee in 2019. So if you want one you will need to order one.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 Marathon? 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 10k + is a bit more than 10k - hence the '+'.* 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 17 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 10K + Entry fee*Affiliated £16.00AffiliatedPurbeck 10K + Entry Fee*Unaffiliated £18.00Unaffiliated Entry FeePurbeck 10K + T Shirt Fee*T Shirt @ £5Not 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 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name Once again thank you for choosing to run The Purbeck 16 for charity. You will shortly receive a confirmation email with further information. Good luck with your training and we'll see you on the 16th September 2018Thank you for choosing to run The Purbeck 16. You will shortly receive a confirmation email with further information. Good luck with your training and we'll see you on the 16th September 2018CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.