Organised by:

JAWATANKUASA KEMAJUAN DAN

KESELAMATAN KAMPUNG (JKKK)
KAMPUNG BUNGA, SERIAN, SARAWAK.
Enquiry:
017-3068596
Registration form:
CATEGORIES:-
Please tick ( √ ) on one relevant category only
( ) Men (Open) 10KM – RM70.00
( ) Women (Open) 10KM – RM70.00
( ) Men Veteran (45 years old and above) 6KM – RM60.00
( ) Women Veteran (45 years old and above) 6KM – RM60.00
( ) Boy’s Junior (17 years old and below) 6KM – RM60.00
( ) Girl’s Junior (17 years old and below) 6KM – RM60.00
( ) FUN HIKE 3KM – RM50.00
PARTICIPANT DETAILS:
Participant’s fullname
IC No/ Passport No
Date of Birth Age
Occupation
Contact No: House H/phone

Permanent Address

E-mail
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DECLARATION BY PARTICIPANTS & INDEMNITY
I the undersigned have read and understood the rules of competition and do hereby
agree here to.
All the information particulars supplied by ourselves are true and if found false we
agree that organizers shall have the right to disqualify us from the competition.
In consideration of being permitted to compete for the events I/ We agreed to the
following:
 I acknowledge that I/ We fully aware of the hazards and dangers invested in the
BUNG SADUNG CLIMBATHON CHALLENGE 2018 and hereby assume all risk
involved in our participation in this event.
 I hereby release, waive, discharge and comments not to sue the promoters,
participants , organizers, ministry, agents, his/ her personal representatives,
assigns, heirs and next of kin FOR ANY AND ALL LOSS OR DAMAGE, ANY
CLAIM OR DEMANDS THEREFORE RELATED TO THE EVENT(S),
WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEES OR
OTHERWISE.
 This agreement binds me, heirs, legatee, personal representatives and all these
claiming through me.
 I/ We HEREBY AGREES TO FOLLOW ALL RULES SET FORTH IN THE
BUNG SADUNG CLIMBATHON CHALLENGE 2018 RULES, and agree to
abide by any penalty(s) set by the organizer.

(……………………………………)
Name:______________________________
NRIC No./ Passport No.:______________________________
Date:______________________________