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  • Entry Form: Charity Run For PDK Maharani

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    ENTRY FORM Date Starting Time Finishing Time Venue Entry Fee RM. FULL NAME :.. SEX. AGE. DATE OF BIRTH. MAILING ADDRESS : (H). SIZE OF T-SHIRT : S XXL Note : first come first serve while stock last.

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    MuarCharityRun

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    ENTRY FORM Date Starting Time Finishing Time Venue Entry Fee RM. FULL NAME :.. SEX. AGE. DATE OF BIRTH. MAILING ADDRESS : (H). SIZE OF T-SHIRT : S XXL Note : first come first serve while stock last.

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    Attribution Non-Commercial (BY-NC)
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    24 views1 page

    Entry Form: Charity Run For PDK Maharani

    Uploaded by

    deoughtred
    ENTRY FORM Date Starting Time Finishing Time Venue Entry Fee RM. FULL NAME :.. SEX. AGE. DATE OF BIRTH. MAILING ADDRESS : (H). SIZE OF T-SHIRT : S XXL Note : first come first serve while stock last.

    Copyright:

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    of 1

    ENTRY FORM

    Date : 01.08.2010 (Sunday)


    Starting Time : 5.30am (21KM), 6.30am (10KM)
    Finishing Time : 10.30am
    Venue : Dataran Tg. Emas, Muar, Johor.
    Entry Fee : RM30 (Include T-shirt & Certificate)
    Closing Date : 25.07.2010
    Charity Run for PDK Maharani

    FULL NAME : ………………………………………………………………………………………………………………………


    IC NO. : ………………………………………………………………… AGE : ……………………………………………
    SEX : ……………………………………… DATE OF BIRTH : …………………………………………………………
    MAILING ADDRESS : ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………
    ………………………………………………………………………………………………………………
    CONTACT NO. : (H) ……………………………………… (MOBILE) …………………………………………………
    EMAIL ADDRESS : …………………………………………………………………………………………………………………
    WISH TO PARTICIPATE IN THE FOLLOWING EVENT :
    Category Distant Please Tick ( √ )
    Men Open 10 KM
    Men Open 21 KM
    Women Open 10 KM
    Women Open 21 KM
    SIZE OF T-SHIRT :
    S M L XL XXL
    Note : First come first serve while stock last
    WAIVER CLAUSE :
    I, the participant hereby agree to abide by the rules and conditions of Payment by cheque payable to:
    the race. I certify that all of the above particulars are correct. I am MCA YOUTH BAKRI DIVISION
    entering the competition at my own risk and shall not hold the
    A/C No. : 3134029106 (PBB)
    organizer responsible for any accident, injury, death, loss of
    property cause before, during and after the race. Or hand in entries to:
    Pusat Perkhidmatan JPMM Bentayan,
    Authorization by parents/guardian of participants under 18 years old. 31-B, Jalan Ali, 84000 Muar, Johor.
    Tel : 06-9539927 Fax : 06-9523636
    I ……………………………………………………………………………
    Parent/guardian of the above named authorize his/her participation For Further Information, please contact:
    in the run. Mr. Lee (0126387831)
    Miss Coco (0123532611)
    Mr. Yew (0126355500)
    …………………………………………….. ………………………………….
    Signature Date
    FOR OFFICIAL USE ONLY
    IC No. : ………………………………………………………………………….

    Entry Fee RM …………..…… Cash/Cheque


    Receipt No. : …………………………………..
    Promoter : Organizer :
    Issue By : ……………………………………….

    JPMM Bentayan MCA Youth Bakri Division

    Co-Organizer :

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