Name:

Address:

Date of Birth:

Club:

Mode of Partaking:

T-Shirt Size:

Signed: _____________________________ Date: __________________

Please print out the completed form, sign your name and insert the date in the space provided. Then return it along with the entry fee to: Anne Condon, Northwest 10k, Letterkenny Chamber, Grand Central Complex, Canal Road, Letterkenny, Co. Donegal.

The entry fee is €15 for walkers and runners with "Chip Timing" for all.