Date: 17th October 23rd October 2011

Registration Closing Date: 2011

Event Details

16st

September

Stage-Race International Riders: USD$400 Local Riders: With Licence - RM150 Without Licence RM165 *Entry rates include free direct entry into Jamboree Ride on 23.10.11 Jamboree Ride International Riders: USD$20 Local Riders: RM60 Payment Details Maybank Acc: 514365203279 Acc Name: Human Voyage (M) Sdn. Bhd. Complete the registration form and proof of payment, then fax it to +603-92221786 or email: info@mtbmalaysia.com

Day 1 17 Day 2 18 Day 3 19 Day 4 20 Day 5 21

42.7km

th th th th st

Oct 2011 RIDERS REGISTRATION & BRIEFING Oct 2011 ROUND ISLAND, 62km Oct 2011 KAMPUNG TOK SENIK RESORT, 7.3km/lap (max: 1h 45mins) Oct 2011 ENDURANCE, Telaga Harbour Park 8km/lap (max: 7hrs) Oct 2011 KING OF MOUNTAIN, Kuah Town to Gunung Raya Hill Resort Oct 2011 KUAH TOWN CIRCUIT, 4km/lap

Day 6 22 Day 7 23
ATTENTION

nd

rd

Oct 2011 MTB OFF-ROAD JAMBOREE 40km / JAMBOREE ON-ROAD 40km

Participants without a valid International race license are NOT ALLOWED to

participate in the 5-DAY STAGE RACE. A temporary license issued by MNCF for the event may be purchased at RM15. Please include amount when banking in payment for LIMBC should you wish to purchase the temporary license.

Participants of the Jamboree Ride Event DO NOT NEED a temporary license. The 5-day stage race is limited to only 1000 participants Both Jamboree rides (On-Road & Off-Road) are limited to only 1000 participants
each.

For more information, visit www.mtbmalaysia.com or email

info@mtbmalaysia.com

1.

Select event (Please cross where necessary) STAGE RACE EVENT Men Elite (19 yrs old to 39 yrs old) Women Elite (19 yrs old & above) Masters Men (40 yrs old to 50 yrs old) Senior Masters Men (51 yrs old and above) JAMBOREE RIDE EVENT (Open to all ages & No race license) MTB Off-Road Jamboree On-Road Jamboree (for Road Bikes only)

2. Please fill in your particulars (In block letters)

MUHAMMAD DANISH ASYTAR BIN AZIZANFull Name I.C / Passport No 951016-02-5143 : CITIZEN Race License No : Team / Club : NORTH RIDERS
Full Name : Nationality : * Additional RM15 for Temporary License for 5-Day Stage Race from MNCF (please tick box if you require to purchase)

City / State : KEDAH D.O.B : (dd/mm/yy) 10.07.2011 Contact No : 019-4298680 Emergency Contact Name RELIZA Emergency Contact No : 019-4053830
Street Address : Yes:

Postal / Zip Code : Country : Gender : Email : Relation :

05350 MALAYSIA
Male Female

danishasytar@yahoo.com MOTHER
XL No

Shirt Sizes : S M L Are you on any medication(s), have any allergies / food allergies or suffer from any previous injury(s)? If yes, please specify: Are you vegetarian? No Yes:

LEGAL NOTICE & DISCLAIMER

The Participant hereby declares and represents to the Organizer that the participant is 19 yrs or above. As a matter of caution, the Participant ought to: i. ii. iii. iv. Have sought medical examination to ensure that the Participant is certified to be medically fit to participate in the Event; Whereby applicable, have sought to ensure that the Participants insurance policy is not void or voidable as a result of the Participants participation in the event; Have ensured that the Participants sporting equipments and safety gears have been recently examined by a skilled bicycle mechanic service and certified for use in such an Event; Have taken cognizance of the fact that the trail designated for this Event is extremely challenging and hence requiring much endurance and skill to surmount.

LEGAL NOTICE & DISCLAIMER (BELOW 18 YRS OLD)

I _______________________________________________________________, the father/mother/guardian HEREBY ACKNOWLEDGE that I have read and fully understood the RULES & REGULATIONS of participation in the Event and hereby consent to LANGKAWI INTERNATIONAL MOUNTAIN BIKE CHALLENGE (LIMBC) 2011 participation and hereby waive any right of claim against the Organizers, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation, organization and/or management of HUMAN VOYAGE (M) SDN. BHD. I further give permission for the free use of his/her name, voices or pictures (still or moving) to be used in any broadcast, telecast, advertising, promotion or any other form of advertising of this and future events. Yours Truly,

I HEREBY DECLARE that I have fully read and fully understood the RULES & REGULATIONS of LIMBC 2011 and I participate in the Event at my own accord without any duress and I hereby confirm my unconditional acceptance of the terms and conditions of participation and hereby waive any right of claim against the Organizer, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation, organization and / or the management of HUMAN VOYAGE (M) SDN. BHD. I further give permission for the free use of my name, voices or pictures (still or moving) to be used in any broadcast, telecast, advertising, promotion or any other form of advertising of this and future events. Yours Truly,

____________________________________ SIGNATURE OF PARENT/GUARDIAN I.C. NO: H/P NO: DATE:

_________________________________ __________________________ PARTICIPANTS SIGNATURE DATE