Phone
:
388 70 06
SHREE BALASINOR NAVYUVAK SANGH
118/120, Ardeshar Dadi Street, V.P.Road, Mumbai - 400 004
ENTRY FORM
"MARATHON RACE"
Date:
____________
Sr. No
_____
Vastipatrak Sr. No:
_____
Participant's Name
_______________________________________________________________
Father/Husband's Full Name
_______________________________________________________________
Address
____________________________________________________________________________
_____________________________________________________________________________
Age
________
Birth Date ____________
Phone Resi. ____________
Off. ___________
Group
Age
Tick Here
Male
Female
Entry Fees
1
Upto 15
2
16 to 30
3
31 to 45
4
46 to 60
5
61 and above
I am interested in Participating in above games & herewith enclosing entry fee.
_________________
__________________
Guardian's Signature
Participant's Signature
Note :
(1)
Guardian's signature is only required for Participant's age below seventeen years (inclusive)
(2)
Incomplete forms will not be accepted
(3)
It is compulsory to mention Vastipatrak Sr. No.
(4)
ONLY ONE FORM SHOULD BE FILLED UP FOR EACH GROUP
Note :
(1)
Forms will be accepted at balasinor Navyuvak Sangh's Office.
(2)
Participant above eighteen years should be member of Balasinor Navyuvak Sangh
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