Larry McGuill Ras na hEireann




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First Name ___________________________ Last Name________________________________________

Address _____________________________________________________

City ___________________________ County ________ Country ____________

Age __________ Sex M F (circle M or F)

Which Race/Event ? ______________ Club Runner Yes No (Circle Yes or No)

Signature _________________________ Club name _____________________________

All club teams must be declared on club team form to be scored as a team.


EMAIL please print clearly ________________________________________________________




In consideration of the acceptance of this entry, I waive all claims for myself, my heirs and estate against all race officials, organizers, sponsors, Dunleer AC and all it's members, and the Ras na hEireann Committee for any injury or illness which may result from my participation in the race. I also state I am in proper physical condition to compete.

Signature (Parent/Guardian if under 18) ___________________________________________________________



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