REGISTRATON FORM CYCLETHON 2017

Event Date : 16th September 2017

Closing Date : 30th August 2017
Venue : Kolej Vokasional Batu Lanchang, Pulau Pinang
Entry Fee : RM50

Name :___________________________________ Gender : Male / Female

Address :__________________________________ Country of Origin :__________________

___________________________________ Contact No :______________________

IC No/Passport :_____________________________ T/Shirt Size : S/M/L/XL/XXL

Email :____________________________________ Category : Fun Ride(10KM) / Challenge Fun Ride(45KM)

To be read and sign by all participants:

(The entry and release form is a contract with legal consenquences upon signing)

1. Release liability, walver of claim and indemnity.

2. Participation is at the participant's own risk. I hereby acknowledged and certified that
* I have sought medical examination and certified to be medically fit to participate in this event.
* I am physicall fit and sufficiently trained to take part in the event.
* I am aware that this event maybe potentially dangerous in an open course environment and may
result in serious injury or death.
* I hereby agree to asume all risk associated in my participation in the event.

3. I hereby declare that i have read and full understood the terms and condition of participation in the
event and at my own accord without duress, hereby confirm my unconditional acceptance of the terms
of participation and hereby walve any right of claim by myself or anyone entitled to act on my behalf
against the organizer, sponsors, event committees or such other parties involved whether directly or
indirectly in the preparation, organization and management of the event.

4. Finally I hereby authorize the organizer to use any photograph, voice or any electronic image taken
of me during the event without any compensation.

Signature :_ _ _ _ _ _ _ _ _ _ __ _ _ _
Name & Date : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Payment Method : Bank in / OnlineTransfer RM50 to responsible treasury :PIBG SM TEKNIK BATU LANCHANG
(MAYBANK :5072 4614 7285)
Please email your bank-in slip to cylethon2017@gmail.com

Kindly be informed that the closing that for registration would be on 30th August 2017
Registration for the confirmation participants attendance starts from 6.00a.m 6.30 a.m at Kolej Vokasional Batu
Lanchang
_ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

For further info contact us at : 0-00000000 (wwww) / 0-32323233 (wwww)

For more information visit : https://www.facebook.com/cyclethonkvbl

**The t-shirt design will b e anounced later...

**The participants must b e 16 years old and ab ove