Batac-Banaue-Batac

REGISTRATION FORM

PERSONAL DATA:

NAME: AGE:
ADDRESS:
BIRTHDATE: SEX: CP NO.:
DRIVER'S LICENSE EXPIRY DATE: RESTRICTION CODE: ________________

MOTORCYCLE DATA:

BRAND: MODEL: DISPLACEMENT:

CATEGORY ENTRY:

___Solo ___Tandem ___Couple ___Trio ___Group of 5 ___Group of 10

Bike #: _____ T-shirt Size: _____

CONTACT INFORMATION IN CASE OF EMERGENCY

NAME: RELATIONSHIP:
ADDRESS: CONTACT NO.: _____

Participant's Name and Signature Date

Affirmation of consent:

Parent’s/Guardian’s/Spouse’s Name and Signature Date

 Batac-Banaue-Batac
WAIVER OF LIABILITY

I hereby affirm, defend and clear the organizers, sponsors and their officers to free and safe from any
indemnity, losses, cost, action, fines, claims, suits, fees, disbursements, liabilities, damages,
judgment, and expenses including, but not limited to, attorney's fees and cost incurred in the
investigation, defense and settlement of claims that I and the organizers/partners/sponsors may
suffer or incur arising from injury, disability, disease, medical treatment of claims and death of person
and/or animal during the implementation, conduct, execution and/or completion of the Batac-Banaue-
Batac Endurance Challenge 2020.

I hereby participate in this event as a true sportsman and a sincere gentleman with utmost concern
for my own safety, for the other participants and the general public. I further confirm that all the
information I specified in this document are true and correct.

Participant's Name and Signature Date

Affirmation of consent:

Parent’s/Guardian’s/Spouse’s Name and Signature Date