Race number
Race number box

Jog Shop Jog
Please send to: The Jog Shop, 39b George Street, Brighton BN2 1RJ
Surname (block letters)
First name
Date of birth
Age on day of race
  Tick box  M Tick box  F
Address (including post code)  
First claim club (or unattached)  
No. of JSJs run
Best time
Email address
Payment enclosed (£12.00 U.K.A. affiliated or £15.00 unattached) cheques to The Jog Shop Jog.
Results ~ extra £2.00.)		 Tick box S. A. E. enclosed Tick box
Results envelope enclosed Tick box
I declare that:
  1. I am 18 years and over.
  2. I will abide by the rules of U.K.A. and The Country Code.
  3. I am fit enough to do the distance.
  4. I will not hold the organisers responsible for any injury or loss however occurred.
Signed  
Date