EmailMe Form - Registration

Team Name

Rider Name *

Age *

Gender *

Category *

Open (All ages below 40)

Veteran (Age 40 and above)

Women

IC Number / Passport *

Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone Number *

### - ### - ####

Contact person in case of emergency *

Emergency Phone Number *

### - ### - ####

AUTHORISATION BY PARENTS/GUARDIAN FOR PARTICIPANT UNDER 18 YEARS OLD

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY. In consideration of organizer of this event, accepting my application to participate in this activity, I agree: To waive any and all claims I may have in future against the organizer and others involved.

I have read and agree to the Terms of Service *

Yes, I agree.

INSTRUCTIONS:

1) Complete dan submit form secara online

2) Buat bayaran di bank-bank berikut:
a) Public Bank: Nurzatul Itri - 4523 1546 26
b) Maybank: Nurzatul Itri - 1550 2333 4692
c) RHB: Rahimah Abu Bakar - 2050 7940 0977 34
d) CIMB: Rahimah Abu Bakar - 0503 0653 2275 27

3) Sila SMS (sms only) to 019 - 395 1487:
- Tarikh dan waktu deposit yang tepat (jam dan minit)
- Nama bank dan deposit amount
- Nama-nama rider