5k Run/walk Entry Form
Entry Fee: £10 and
Includes a DMH Branded T shirt.

Entry is £15 on the day.

You can fill in the form below and pay securley online for your entry or alternatively print off an entry form here.

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Your Details
Title*
First Name*
Last Name*
Address*

Town/City*
Post code*
Telephone*
Mobile
Email*
Date of Birth* dd/mm/yyyy
In Memory Of
*indicates a required field.
Entry Details
Entry type*
Affiliated Runner
Unaffiliated Runner
Walker
Name of club

Runners
If you are a member of the North Staffs Road Runners please enter your number here

If you are a member of UK Athletics please put your membership number here
Age on
race day*

Dougie Mac
T-shirt size*
(included in entry fee)
Small
Medium
Large
Extra large


Online Entry Fee: £10.00
Includes a Dougie Mac T-shirt

Please click the proceed button below to pay for your entry fee

proceed to payments

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