Entry Form for 12-hour time trial

Best result at nearest distance during current and part 3 seasons:

Distance: eg, 10-mile
Event: eg, CC Breckland Open
Date: eg, 28 May 2019
Time: eg, 25:40
Position (if known): eg, 15
Winner (if known):
Winner's Time (if known): eg, 20:15

Best result at nearest distance since Jan 1st last year

Distance: eg, 10-mile
Event: eg, CC Breckland Open
Date: eg, 28 May 2019
Time: eg, 25:40
Position (if known): eg, 15
Winner (if known):
Winner's Time (if known): eg, 20:15

Personal Details

Title Forename(s) Surname
Club District
Address
Postcode
Tel Mob D.O.B
Email

Emergency contact details

Name
Address
Tel Mob

Not all fields are filled in automatically; you should check all of the printed form carefully, and don't forget to sign & date it!

You can also use this system for time trials that have an online entry option. As long as you've supplied your best results (at each distance) for each year that you've been competing, visit this page to see the correct results to put in the online entry form.

None of the information you enter here will be shared with third parties. If you have any questions, concerns or suggestions about this system, please let me know!