First Name

Date of Birth

Surname

Telephone

Address

Town

County

Post Code

Team Sponsor

E-mail

BC Membership No

Event

Date

Venue

Category

Age or year born

Tick

Fee

Age at 31/12/03

Years

Elite

16 and above

£25

Juvenile Class – Must be at least 12 years of age on race day.
Novice – 12-15 & 16+ Prizes for the top 3 novices at each round will be awarded.
All riders (except Novice) must be Silver of Gold members of British Cycling for 2004.
No riders will be allowed to race in the series categories without membership to British Cycling.  Membership Forms download from British Cycling website
Number Boards issued at signing on, you will keep this number for all the series.
Lost or if you forget your number board will incure £5 replacement charge.
NO STICKERS to be affixed to the number boards. Series Sponosrs only.
A front brake is not required to race.
Best 4 from 6 events to count for Series.

To help us to a free T-shirt for entering 3 race or more. Need to state Chest size when registering.

If you pre enter 3 or more races, you wil get a free ex-gear 4X Series T-shirt.
Please state chest size when registering. M - L - XL

Senior

1985 to 1975

£20

Master

1974 and before

£20

Junior

1986-1987

£20

Youth

1988-1989

£20

Juvenile

1990-1991

£20

Novice

12-15 (1989-1992)

£20

Novice

16+ (1988& older)

£20

Entry on the day add £5

Total number of races entered

Total Entry Fee (s)

I hereby apply to participate in the event(s) indicated above.  I or my parent/guardian accept and agree that neither the organizers, nor their agents, officials, the landowners, sponsors or fellow competitors shall be liable in any way, or in any circumstances for any damage or injury that I may suffer during, in connection with, or as a result of taking part in this event. I will abide by the rules of the series.  I agree that I participate in this event entirely at my own risk and that I must ride in a manner which is safe for all others and myself.  I also declare that the cycle I will ride in the event is in good working order and properly maintained with front and rear working brakes.

Signed ………………………………………………..Parent/Guardian (if under 18):    Date………………………….
ENTRY INVALID WITHOUT SIGNED DECLARATION (No entries accepted without payment or post-dated cheques)
Returned cheques would incur a £5 charge. Please supply name address of cheque holder if different from the competitor.
Please make cheques payable to NPS4X and send this form and cheque to:
NPS4X Central Entries, 25 Wrekin walk, Stourport-on-Severn, WORCS, DY13 0LR
Check www.nps4x.com confirmation of entry. Refunds only if in writing 7 days before race, entries will only be transfered after this date.
Email enquiries; chris.roberts@nps4x.com or Tel: 07702 826260