EmailMe Form - Kiara Downhill Domination 2012

Team Name
Name *
First Last
Gender *
Male
Female
Age *
Date Of Birth *
MM / DD / YYYY
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Email *
IC No. *
Mobile Phone *
Phone No
Emergency Contact *
Phone *
Category *
Junior : 17-19 years old
Hardtail : Open to all hardtaillers
Sport/Open: 20-29 years old
Master A : 30-35 years old
Master B : 36-40 years old
Master C : 41 and above
Elite/Expert : Sponsored / State Rider
Bank-in Slip - Prove of Payment
Note :
Note ; If 18 or under, Signature of Parent or Guardian is required Below. The undersigned parent and natural guardian or legal guardian does hereby represent he/she is, in fact acting in such capacity and agrees to save, hold harmless and indemnify each and all of the parties referred to above from all liability, loss, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guadian.
Parents/ Guardian Name
Disclaimer
This form must be submitted along with payment in full, for each rider. Submittal Of This form constitutes the agreement that the organizers are not held accountable for any injuries or death that may occur during the event. The undersigned hereby acknowledges that this is an agreement, in which the organizer shall not be held liable towards any lawsuit, which may be revoked anytim by yhe organizers, sponsors or Freeride Malaysia.