| First Name* | |
| Last Name* | |
| Gender* | |
| Email* | |
| Date of Birth* | DD/MM/YYYY format (e.g. 28/10/1980) |
| Mobile Phone* | Your primary contact number |
| Athletics/Running Club | |
| Corporate Team Name | |
| T Shirt Size* | |
| Number of Events* | Estimated number of races you plan to run |
| Athletics NI Athlete Registration Number | |
| Athletics Ireland Athlete Registration Number | |
| Validation* | 9 × 4 = ? |
| Consent to Marketing* | I consent to receiving CANCOM 10K Grand Prix updates and communications from ChampionChip Ireland and CANCOM |
