Registration of Interest for The Simplyhealth Great Birmingham 10k, Sunday 26th May 2019

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* 1. First Name(s):

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* 2. Surname:

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* 3. Gender:

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* 4. EA Affiliated Club:
Note: Athletes should enter their EA Affiliated First Claim Club only

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* 5. England Athletics Athlete Registration Number (URN):
Note: Athletes can find their URN Number by searching for their name and date of birth on the EA Licence Checker

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* 6. Email Address:

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* 7. Date of Birth (DD/MM/YY):

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* 8. Primary Qualifying Race (If you are racing more than one of the events listed below please select the FIRST by date that you will be competing in):

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* 9. Additional Qualifying Races (If you are competing in more than one of the qualifying races please select below the second and/or third qualifying races you will be competing in):

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* 10. Age Group (At Time of Qualifying Race):

Please Note: 
(i) Athletes can only qualify in the age group they are in at the time of the qualifier and that is the age group athletes should log at point of registration (above).
(i) Any athletes that subsequently qualify for an England vest and have a birthday that falls between the qualifier and the representative race will race in the their new age group as an England representative.

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* 11. I understand selections are subject to competitive fitness. I agree and understand to my details being held by England Athletics and used for the purposes of the selection and administration of the Masters' Marathon teams. This may include sharing data with the organisers of the events for the purposes of administering the selection process.

Thank you for your expression of interest in the England Athletics 2019 Masters Teams. Unfortunately we cannot reply individually to each application. By clicking submit at the end of this form your expression of interest will be saved automatically. Those successful in qualification will be contacted in good time prior to The Simply Health Great Birmingham 10k 2019. We wish you all the best in training for your qualifying race.

Please not that this registration link does not generate an automatic confirmation email, therefore if you would like to keep a record of your registration we recommend you take a screen shot before pressing submit.

More information on England Athletics Masters opportunities can be found HERE

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