EmailMe Form - Beat My Time 2011

Team Name
Name
First Last
Gender
Male
Female
Age
Email
IC Number / Passport
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone
Category
ELITE
OPEN
MASTER A
MASTER B
JUNIOR
ZERO-FIVE
WOMAN
Section Break
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY.
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 involve
AUTHORISATION BY PARENTS/GUARDIAN OF PARTICIPANT UNDER 18 YEARS OLD