ENGINEER'S RUN 2015

Organised By

INDIVIDUAL FORM
SUNDAY, 13 SEPTEMBER 2015, 6.15 A.M
DISTANCE CATEGORY

13KM
(Tick )

Early Bird: RM 65
(Until 01/06/15)

IEM SABAH
Early Bird: RM 50.00
(Until 01/06/15 )

6KM
(Tick )

Normal Fee: RM 80

Normal Fee: RM 70

DETAILS
NAME
ADDRESS
IEM MEMBERSHIP NO

I/C / PASSPORT NO
GENDER

MALE

(Tick )

DATE OF BIRTH

AGE (AS OF 31 DEC 2015)

(DD/MM/YY)

CONTACT NUMBER

E-MAIL
TEE SIZE*

NATIONALITY

FEMALE

(Circle O)

XXS

XS

XL

XXL

*MEASURMENT
TO BE PUBLISHED

EMERGENCY CONTACT NAME

RELATIONSHIP

EMERGENCY CONTACT NUMBER

CATEGORY (Tick )
MEN'S OPEN (10YR OLD-44YR OLD)

WOMEN'S OPEN (10YR OLD-44YR OLD)

MEN'S VETERAN (45YR OLD & ABOVE)

WOMEN'S VETERAN (45YR OLD & ABOVE)

WAIVER
In consideration of my participation in the ENGINEER'S RUN 2015, I agree to assume all risks incidental to such participation (which risks may include, among other things,
muscle injuries, heat and stress related issues and broken bones). On my own behalf, and on behalf of my heirs, executors, ad ministrators and next of kin, I hereby release,
covenant not to sue, and forever discharge the Released Parties (as defined below) of and from all liabilities, claims, actio ns, damages, costs or expenses of any nature arising
out of or in any way connected with my participation in the ENGINEER'S RUN 2015 and further agree to indemnify and hold each of the Released Parties harmless from and
against any and all such liabilities, claims, actions, damages, costs or expenses including, but not limited to, all legal fe es and disbursements up through and including any
appeal (Claims). I understand that this release and indemnity includes any Claims based on the negligence, action or inacti on of any of the Released Parties and covers
bodily injury (including death), property damage, and loss by theft or otherwise, whether suffered by me before, during or af ter such participation. I declare that I am
physically fit and have the skill level required to participate in the ENGINEER'S RUN 2015. I further authorize medical treat ment for me, at my cost, if the need arises. For the
purposes hereof, the "Released Parties" are THE INSTITUTION OF ENGINEERS, MALAYSIA(Sabah Branch) and all ENGINEER'S RUN 2015 sponsors or charities, and each of their
respective parent, subsidiary, affiliated or related companies
I further grant the Released Parties the right to photograph and/or videotape me and further to display, use and/or otherwise exploit my name, face, likeness, voice, and
appearance forever and throughout the world, in all media, whether now known or hereafter devised, throughout the universe in perpetuity (including, without limitation, in
online webcasts, television, motion pictures, films, newspapers, and magazines) and in all forms including, without limitatio n, digitized images, whether for advertising,
publicity, or promotional purposes, including, without limitation, publication of ENGINEER'S RUN 2015 results and standings, without compensation, reservation or
limitation, or further approval, and I agree to indemnify and hold harmless the Released Parties for any Claims associated wi th such grant and right to use. The Released
Parties are, however, under no obligation to exercise any rights granted herein.
This Waiver and Release Form shall be governed by the laws of Malaysia. I certify I am 18 years of age or older and the infor mation set forth is true and complete.
In consideration of your minor child being permitted to participate in the ENGINEER'S RUN 2015 you hereby attest that, after reading this Waiver and Release Form
completely and carefully, you acknowledge that participation in the ENGINEER'S RUN 2015 by your child is entirely voluntary, and that you understand and agree as the
following above

PARENTS / GUARDIAN SIGNATURE(MINOR)

OFFICE USE:

EARLY BIRD

NORMAL FEE

6KM
13KM

RM 50
RM 65

RM 70
RM 80

PARTICIPANT'S SIGNATURE

ORDER NO:
RECEIPT NO:
Organised By