DSE21 Go Kart 2007 Entry Form

To enter a team in this years endurance event please complete and return the following form to Mary Schultz at the address below.

I / We wish to enter _________ No. of teams in this years event.

Team Names : ________________________________

________________________________

________________________________

Your Details:

Name: ________________________________

Address: ___________________________________________________

___________________________________________________

Contact No: _____________________ Mobile No. ____________________

E-mail: _______________________________

Deposit Included: ____________ (minimum £50 / team)

Cheques made payable to Down Syndrome Extra 21

I/We are unable to take part in this event but wish instead to make a donation to the charity.

Please find a cheque for £ __________ enclosed.

Please return this slip complete with deposits to:

Mrs M Schultz

92 Longstomps Avenue

Chelmsford

Essex

CM2 9LB

01245 259742

mary29@blueyonder.co.uk