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LEICESTERSHIRE & RUTLAND AA and WARWICKSHIRE COUNTY AA
TRACK AND FIELD CHAMPIONSHIPS - Pingles Stadium, Nuneaton, CV11 4LX
rd
th
SATURDAY 23 and SUNDAY 24 MAY 2015
POSTAL/PAPER ENTRY FORM FOR PARALLEL SUCCESS EVENTS
(Online entry link on the County websites – see last line below)
Athletes with a UKA / INAS / BBS Classification can enter irrespective of where they live or were born
Please sign below to confirm that you have read the Prospectus, agree to the Terms and Conditions and seen the
draft timetable. For athletes under 16 this form must be signed by a parent/guardian otherwise your entry will not
be accepted.
NAME (CAPITALS):
ADDRESS
(INCL POSTCODE)
LANDLINE/MOBILE
E-MAIL:
GENDER: (M/F)
AGE GROUP:
D.O.B.
Your EA Number:
CLUB (OR SCHOOL):
COUNTY QUALIFICATION ( For L&R and Warwicks only ):
COUNTY (PLEASE CIRCLE ONE):
PLEASE CIRCLE ONE
LEICS & RUTLAND
Birth
Residence
HM Forces
WARWICKSHIRE OTHER ?
Which?
EVENTS ENTERED
EVENT (MAXIMUM OF 3 PER DAY) – DELETE
EVENTS AS APPROPRIATE
100m – ambulant and wheelchair
200m – ambulant and wheelchair
400m - wheelchair only
1500m – ambulant only
Shot – ambulant only
Discus – ambulant only
Javelin – ambulant only
Long Jump – ambulant only
UKA/INAS /BBS)
CLASSIFICATION
DAY (Sat./Sun.) – CHECK
PROSPECTUS FOR DAYS
for each gender
Best Last Season for
seeding
SATURDAY only
SATURDAY only
SATURDAY only
SUNDAY only
SUNDAY only
The entry fee is £10 for each day up to a maximum of 3 events per day for Parallel Success athletes
We will confirm receipt using the Email address or mobile number given above. If you do not get confirmation that your entry
has been received you should assume that it has not arrived. It may have been wrongly addressed, wrongly stamped or lost in the
post. The organisers are not responsible for such errors. Enter early to allow time to correct problems and receive confirmation.
Do not go to the meeting expecting to compete unless you have confirmation that we have received your entry.
Send your Entry form and correct fee to: Ray Morgan, 5 2 G o l f L a n e , L e a m i n g t o n S p a , C V 3 1 2 P T
CLOSING DATE for paper entries - 10.00 am on FRIDAY 8th MAY 2015.
LATE ENTRIES OR ENTRIES ON THE DAY WILL NOT BE ACCEPTED
Please do not staple cheques and forms together because we have to separate them.
 I agree to the Terms and Conditions and have read the Parallel Success 2015 Prospectus
and Timetable
 I enclose the full entry fee for all the events entered above
£ ...........
(Cheques/P.O. to Warwickshire County AA)
Signed by athlete (or athlete’s parent or guardian) ............................................................
Address any queries to: twocountychamps@btinternet.com
Do NOT call the stadium or Midland Counties or UKA - they cannot help you with this event.
A full timetable will be available on the County websites soon after the closing date.
Go to: www.LRAA.org.uk
OR www. WarwickshireCountyAA.co.uk