PEMBROKE - SWIEQI ROAD RACES - 2009

15th Edition
FEXCO WESTERN UNION 10 km RACE KYOCERA mita 5 km RACE
SEDQA 3 km RACE NIKE 3 km RACE
SAFARI FRUIT JUICES 1.3 km FUN RUN
OFFICIAL ENTRY FORM
(UNDER MAAA RULES) CLOSING DATE - TUESDAY 24th MARCH ‘09

Please fill in using BLOCK LETTERS

SURNAME: NAME:

ADDRESS:

POST CODE

NATIONALITY TEL No.:

TICK FEMALE MALE
SEX: DATE OF BIRTH:
NAME OF CLUB /SCHOOL
TICK AGAINST THE RACE YOU ARE RUNNING.
RACE SUNDAY 5th APRIL 2009 TIME FEE TICK BOX

1. 10 km (Born ’89 or BEFORE (senior &veterans)

Including Pembroke & Swieqi Residents 08.30am €12
2. 5 km (Born ‘93 or BEFORE ) 08.30am €7
3. 1.3 km FUN RUN (FOR ALL AGES) 10.00am €5
4. 3 km (Born ’96 and ’97 - cadets) 11.00am €7
5. 3 km (Born ’94 and ’95 - youths ) 11.30am €7
Entries from abroad will be charged a flat rate of 12 Euro for any of the races. In accordance with
MAAA regulations children born in 1998 or AFTER can ONLY take part in the FUN run.
To qualify for the special locality prize, Pembroke & Swieqi residents running in Race 1 or in Race 2
must be in possession of a Maltese I.D. Card which may be requested in claiming the locality prize.
DECLARATION: On acceptance of this entry I the undersigned declare that I am physically fit to participate
in the race indicated; undertake to abide by the rules governing the race; and will not hold the organizers or
sponsors responsible for any injury, loss or accident sustained as a consequence of my participation in the
PEMBROKE / SWIEQI-2009 RACES.
The organizers pledge that Personal information divulged in this application is to be used solely for race
administration purposes, in accordance with the Data Protection legislation of the Republic of Malta.

______________________ ________________________________________________
SIGNATURE PARENT’S SIGNATURE (IF UNDER 16 YRS OF AGE)

I enclose herewith cash or a cheque/money order, No: _____________ being the amount due in respect of my/our
entry fee/s. Entries, accompanied by the appropriate fee or cheque/s are to be made payable to the
PEMBROKE ATHLETA – ATHLETIC SECTION and posted to:
Mr Anthony Fava, “Kottage Keep” Triq B’Kara, San Gwann SGN 4193 - Tel:(356) 79261658 or to
Mr Victor Camilleri, “Mirammiti” 80, Triq Sghajtar, Naxxar NXR 05 - Tel:(356) 99255595

E-MAIL: pembrokeathleta@gmail.com (This Form can be photocopied)