Title Sponsor

Associate Sponsor

This entry form covers application for only for the following race categories – Dream Run (6 km), Senior Citizens' Run (4.3 km) and Wheelchair Event (2.5 km). Please note, registrations for Marathon and Half Marathon are now closed. Please go through the information given hereunder thoroughly prior to submitting your entry. Looking forward to your continued patronage.
Race/Distance Dream Run (6 km) Sr. Citizens' Run (4.3 km) Wheelchair Event (2.5 km) Min. Age Eligibility Born on or before 15.01.1999 (12 yrs) Born on or before 15.01.1951 (60 yrs) Born on or before 15.01.1999 (12 yrs)

You can apply for the Event using any one of the following modes. Entries will be accepted up to Saturday, 25th September 2010 or as soon as running places are filled, whichever is earlier. • Online – through the event website www.procamrunning.in. • Post – Post filled entry form and requisite entry fee to P.O. Box No. 11017, Marine Lines Post Office, Mumbai - 400 020. • Deposit in Bank – Local Mumbai residents can deposit their entry forms along with requisite entry fees at the following Standard Chartered Bank branches in Mumbai. Bank timings: 10 am to 6 pm from Monday to Friday, and between 10 am and 4 pm on Saturday – (1) 87, Bhulabai Desai Rd, Breach Candy; (2) 90 M.G Road, Fort; (3) Shivaji Mandir, NC Kelkar Rd., Dadar; (4) Unique Centre, Waterfield Rd., Bandra (West); (5) 170-A Derasar Lane, Ghatkopar (East), TPS II; (6) Ameya House, Rajkumar Corner, J. P. Road, Andheri (West); (7) Garden Apartment, Diamond Garden CHS Ltd., A Sores Rd, Chembur; (8) Aditya Apartments, Chandravarkar Rd., Borivali (West); (9) Emerald Plaza, Block No.2, Pokahran Rd. No. 2, Thane 400601; (10) Junction of Juhu & S V road, Santacruz. Forms can also be downloaded from the event website www.procamrunning.in. In Mumbai, forms are available at the Standard Chartered Bank branches, the Asian Heart Institute at Bandra Kurla Comlpex, Bandra (East), Mumbai and the United Way of Mumbai office at 309, Kewal Industrial Estate, Senapati Bapat Marg, Lower Parel (W), Mumbai.

Applicable for Domestic Applicants (applicants residing in India) Application type/Fee constituent Domestic Applicants (applicants residing in India) *Overseas Applicants (applicants residing outside India) Dream Run 500 USD 25 Sr. Citizens' Run 300 USD 15 Wheelchair Event 300 USD 15

*Applicable for Overseas Applicants (applicants residing outside India. Overseas applicants are required to apply only online through the event website - www.procamrunning.in)

• Cheque (Only local Mumbai cheques will be accepted) • Demand Draft/Pay Order (payable at Mumbai) • Cash (Only Indian Rupee currency will be accepted) • Credit Card, Net Banking and Debit cards (Can be used only for online application) Note: (i) All cheques and demand drafts to be drawn in favour of “PROCAM INTERNATIONAL LTD. – SCMM”, (ii) Please write your full name, the race category chosen and contact number on reverse of cheque/demand draft.

1) You may use a photocopy of the physical or downloadable form from the event website, to send in your application. 2) Only one applicant can apply for the Event using a single form. Also, do not send in more than one entry per person; multiple applications will entail all being rejected. 3) Applicants must submit their entries only via the Application Modes given in this form. No individual/group has been authorised to collect entries on behalf of the Event.

d) Each group must submit their applications together one time. 10 am to 7 pm) Website: www. log on to the event website www . Lower Par el (W). Where your entry is not confirmed for any reason. ii.in. Mumbai 400013 (Mon to Fri. Acceptance letters and event information will be posted on the address given in the entry form. d) Signed the 'waiver' in the entry form. Procam International Ltd. in a single envelope under a covering letter stating – i. b) Affixed a copy of your latest passport sized photograph on the form. Refund queries will not be entertained post 30th November 2010. For more information on fundraising.procamrunning. your application will not to be accepted.procamrunning. the proceeds going for the benefit of the chosen NGO.in E-mail: scmm@procam. You can also check the status of your entry post 30th September 2010 on the event website.in Health Equipment Partner Sports Drink Partner Logistics Partner . Alternatively.. 13) Confirmed participant's identity and proof of residence may be verified by a verification agency hired for validating the details provided by you in the form. 7) Group applications: a) Where 20 or more individuals submit their applications together. 12) All confirmed participants / their authorised representatives .4) Before sending in your application. against a fee of 50/-. Don't just run. 10) Any refund discrepancies must be brought to the attention of the Event Registration Team immediately.in. log on to event website: www. If you do not receive any intimation from the race office. c) Please DO NOT club Marathon and Half Marathon applications with group applications. iii. applicants residing in Mumbai can also avail of a Pledge Raising Kit from the Event's Charity Partner. 10 am to 7 pm). The applicant alone shall be entitled to the rights and benefits arising out of such confirmation of participation. An amount of Rs. please contact our event helpline number or email us at scmm@procam. 30 will be deducted as processing charges. and cannot be transferred to any other person under any circumstances.in. free of cost. The attendant is required to fill in a separate form and submit the same along with the form of the wheelchair event participant. 11) Requests for cancellation and thereby. 8) Post close of registrations. the guardian has also signed the 'waiver' and written his/her relation with the applicant. United Way Mumbai. the entry fees paid by you will be refunded on or before 31st October 2010. amount and bank name of cheque/DD submitted. 9) Entries not accepted: Participation in the event is subject to entry confirmation.procamrunning. Kewal Industrial Estate. Name and contact details of a common point of contact for the group. RUN FOR A CAUSE Participants who wish to raise pledges for a charity of their choice can download the Pledge Raising Kit. For information on the list of participating NGO's having such charity running numbers and for rules guiding availability of such numbers. marking the said form as “Attendant of _______ (name of wheelchair event participant)”. mentioning the group name and size of the group. 15) This entry form and the right to participate in the event and the rights and benefits available to the applicant under this entry form is at the sole discretion of the event Promoters. Run for a Cause! EVENT CONTACT DETAILS Event Helpline: +91 22 42020200 (Mon to Sat. c) Enclosed the requisite application fees (refer to 'Application Fees' chart). Senapati Bapat Marg. No running number or goodie bag will be posted to individual mailing addr esses. date.are required to come to the Standard Chartered Mumbai Marathon Expo scheduled from 12th January 2011 to 15th January 2011 in order to collect their running number bibs and goodie bags. email confirmations will be sent to all the confirmed participants who have given their valid email id in the entry form. All members of a group have to fill and sign individual application forms. b) More than 150 applications from any single group/entity or association will NOT be accepted.in. Such charity running places will be available at a premium. d) Only one cheque/DD will be accepted for group applications. please check the following – a) Filled in details against all mandatory fields prefixed with '*' in the application form. Total number of applications enclosed in each race category. refund will not be entertained. Under 'Application T ype' in the application form.procamrunning. List of participating NGOs registered with United Way of Mumbai can be viewed on the event website. 5) Where any discrepancy is found in the above mentioned mandatories. Number. applicants need to choose 'Group'. e) If applicant is below the age of 18 years. at 309. this will constitute a group entry. 6) We recommend Wheelchair Event participants be accompanied by an attendant on race day. Such applications will be disqualified. No entry fee is charged for the attendant. from the event website: www. 14) Unsuccessful applicants can approach participating NGO's for available Charity running numbers.

/ Mobile No.4. Retired.2011 * Tel.01.000 15.) * I/my ward do agree to receive information. Number: (STD Code) (Telephone No. NGO.001 & above any one): ü 5. Senior Citizens' Run & Wheelchair Event = Chosen your race category (any one)? = Filled all mandatory fields (marked ‘ ’)? Dream Run.2 inch x 1.001 to 15. Senior Citizens' Run & Wheelchair E * Race Category (tick ü any one) Dream Run . Student Monthly Household Income ( < 5.001 to 100. Senior Citizens' Run & Wh Dream km Wheelchair Event . Check List: Have You…. Senior Citizens' Run & Wheelchair Event APPLICATION FORM Senior Citizens' Run & Wheelchair Event APPLICATION FORM Dream Run.5Run.) * Last Name: * City/Town: * State: * Nationality: (dd/mm/yy) Age as on 15. any one): ü Self-Employed.000 100.3 km Dream Run. pamphlets.001 to 200. Housewife. sampling and advertising of various brands/products/services as may be sent to me/my ward by the event promoters (or any other person duly authorized by the promoters) on the contact details given by me/my ward in this entry form: Yes No .Address: (STD Code) (Telephone No.000 200.6 km Senior Citizens' Run .000 * Contact name & number of family/friend/guardian in case of emergencies: * Name: * Tel. offers. = the Entry Guidelines and Regulations? Fully read = recent passport sized photograph? Affixed your APPLICATION FORM Dream Run.001 to 50. Senior Citizens' Run & Wheelchair Event = Included the correct applicable fee? = Waiver? Signed the Dream Run./ Mobile No. Senior Citizens' Run & Wheelchair Event * Application Type Individual Application / Group Application Group Name Group Size Type of Group: (Group size not to be more than 150 people) Corporate. ) (tick Service.2 inch) recent Photograph Dream Run. Senior Citizens' Affix your Size (1. Number: Occupation (tick Business.2.000 50.Title Sponsor Associate Sponsor Dream Run. Others: (please specify) Personal Information * First Name: *Address: * Area: * Landmark: * Pin Code: * Gender: Male Female * Country: * Date of Birth Email . Senior Citizens' Run & Wh Dream Run.

an appropriate level of fitness to participate in such a physically demanding event and l/my ward have obtained a medical clearance from a registered medical practitioner. waive all claims of whatsoever nature against any and all Sponsors of the event. none of the sponsors of the event or any political entity or authorities and officials or any contractor or construction firms working on or near the course. agree and irrevocably permit Procam International to share the information given by me/my ward in this application.Charity (tick ü any one) Do you wish to support any of the following causes given below – you can choose more than one cause: Education Disability Women Empowerment Rural development Elderly Others You will be contacted on your email id and will be guided on how to support the cause selected by you. authorities and officials.01. allowing me to participate in the event/s. (xii) I/my ward understand and agree to the event terms and If applicant is under 18 years of age as on 15. I hereby irrevocably authorize the event officials and organizers to. at my/our risk and cost. *Payment Information Cheque Chq/DD No. employees. for the sole purpose of promoting the Standard Chartered Mumbai Marathon. Mumbai City. all political entities. employees. but not limited to. (I) the information given by me/my ward in this entry form is true and me/my ward is/am solely responsible for the accuracy of this information. (vii) shall provide to race officials such medical data relating to me/my ward as they may request. confirm and agree as follows and I/my ward …. with all/any entities associated with the Standard Chartered Mumbai Marathon. officials or volunteers or Procam International Limited or any persons or entities associated with the event or the directors. typhoons or any terrorist act. even if the course may be regulated/ policed. earthquakes. any claims that might result from me/my ward participating in the event and whether on account of illness. all Standard Chartered Mumbai Marathon Committee persons.: (tick any one) ü Demand Draft Cash Amount in Chq/DD Date: (dd/mm/yy) Cheque / DD in favour of “PROCAM INTERNATIONAL LTD. (viii) in case of any illness or injury caused to me or my ward or death suffered by me or my ward due to my/my ward’s participation or any force majeure event including but not limited to fire.procamrunning. (ix) understand. at its own discretion. at its own discretion. injury. (ii) have fully understood the risk and responsibility of participating in the Standard Chartered Mumbai Marathon or any event outlined in this application (collectively "the events") and will be participating entirely at my/his/her risk and responsibility. all contractors and construction firms working on or near the course. Procam International Limited and all other persons and entities associated with the event and the directors. (iii) understand the risk of participating on a course with vehicular traffic. (x) understand.2011 Guardian's Signature Name & relation of Guardian with Applicant Applicant's Signature www. death or otherwise. transport me/my ward to a medical facility and/or to administer emergency medical treatment and l/my ward waive/s all claims that might result from such transport and/or treatment or delay or deficiency therein. riots or other civil disturbances. officials and volunteers.in . or any of the Standard Chartered Mumbai Marathon Committee persons. agents or representatives of all or any of the aforementioned shall be held liable by me/my ward or my/my ward's representatives.SCMM” Bank Name & Branch: *Refund Refund cheques (after deducting processing charge of Rs 30 per application) to be drawn in favour of *Waiver (Must be signed for entry acceptance) I declare. (vi) agree that if I am/my ward is injured or taken ill or otherwise suffer/s any detriment whatsoever. agree and irrevocably permit Procam International to use my/my ward's photograph which may be photographed on Race Day and/or during the Standard Chartered Mumbai Marathon Expo. storms. (iv) understand that l/my ward must be of. (xi) shall not hold the organizers and all/any of the event sponsors responsible for loss of my/his/her entry form and/or entry fee in transit. . and must train to. I agree that nothing herein shall oblige the event officials or organizers or any other person to incur any expense or to provide any transport or treatment. agents and representatives of all or any of the aforementioned including. (v) for myself/ourselves and our legal representatives. I shall pay or reimburse to you my/my ward's medical and emergency expenses and l/my ward hereby authorize/s you to incur the same.

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