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POPX GROUP Registration Form
Get 30% OFF for a group registration that consist of 6 swimmers. Valid till 15 March 2020
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Swimmers 1
** You may pause & resume later
POPX Tshirt
IMPORTANT NOTICE :
For Safety reasons, swiming buoy is mandatory to ALL participants of POPX.
You can bring your own buoy
Group Personal Accident is provided by MSIG Insurance (M) Bhd.
MYR25,000/USD6000 for Death and Permanent disablement
MYR2000/USD480 for Medical Expenses
Premium is MYR15 / USD3.60 (including SST and stamp duty)
Name of Group / Club
*
Name of Person In Charge
*
Email
Swimmers' Personal Information
Swimmer 1
*
Name
Email
Mobile No (Country Code + HP No)
Date of Birth
Age (on 4 April 2020)
Gender (F/M)
Nationality
Personal Document (Passport/ MNRIC)
Passport / MNRIC No
Previous OWS participant? Y/N
Year of Last participation (Type 0 if first time)
T-Shirt Size
Buy Swimbouy? Y/N
Need Group Personal Accident for the event? Y/N
Selected Swim Distance Category (500m/1km/3km/6km)
In case of accident contact
*
Name
Mobile Phone No.
Country Code + Mobile No
For e.g 60102345678
Parent/Guardian (for swimmers age 7 - 17)
Name
Relation (Father/Mother/Other: please state)
1
/
6