Name (required)

Surname (required)

Sex (required)
MaleFemale

Address

Your Email (required)

Date of Birth (dd/mm/yyy) (required)

Age on day of race (required)

Telephone (required)

Mobile No. (required)

Name of club (if any)

Next of kin name (required)

Next of kin contact number (required)

Terms and conditions

I declare that I will abide by the eligibility rules and competition rules of M.A.A.A. and St.Patrick’s A. C. I accept that the organisers, helpers & sponsors will not be liable for any loss, damage or injury I may sustain as a consequence of my participation in the St Patrick's AC road races. I declare that I have trained sufficiently for the event and that a medical doctor has monitored my physical condition over the past few months and that I am fit to run this race.I hereby declare that the above particulars are complete and correct.

I Accept These Terms and conditions (Tick the box below)