registration form - AMC The School of Business

REGISTRATION FORM PERSONAL DETAILS

IN CASE OF EMERGENCY, PLEASE NOTIFY:-

Full Name

:

__________________________

Name

:

_____________________________

Gender

:

__________ (F) __________ (M)

Contact No

:

_____________________________

NRIC/ Passport No

:

__________________________

RUNNER CATEGORIES (Please tick (√)) :

Nationality

:

__________________________

Category

Residential Address :

__________________________

10KM Open (19 – 50 years old)

M

Veteran Open (5KM) (51 years old & above)

M

Student Open (5KM) (13 – 18 years old)

M

__________________________ Contact No

:

__________________________

Email Address

:

__________________________

Tee Size (Please (√)) XS

S

: M

L

XL

XXL

Fee (RM) F F F

Tick

60

60 50

For international applicant addition RM10 will be charged

REGISTRATION WILL BE CLOSED ON

30TH JUNE 2016

A registration fee must accompany this enrolment form. This is NOT refundable under any circumstances.

WAIVER CLAUSE

Authorised by Parents/Guardian of Participants under the ages 18 (If applicable only)

I, Participant, hereby agree that this is a charity run and will abide by the rules and regulation of this event. I certify that the stated particular are correct. I am entering the event at my own risk and shall not hold the organiser or any authorities responsible for any accidents/ death / loss of property howsoever caused before, during and after the event. FOR OFFICE USE ONLY Entry Fee: RM Receipt No: Issued By:

I, __________________________ parents/guardian of the stated participant hereby authorise his/her participant in the AMC College Charity Run 2016. Signature Date

_________________________________ _________________________________

 Registration for the race is only confirmed upon

payment and issuance of a confirmation slip.  All Participants must collect their goodies bag (1)

week before the event. Participants will get a Teeshirt and BIB number collected at AMC The School of Business. Form and payment submission to: AMC College Charity Run 2016 Co-ordinator AMC The School of Business, Lot 43-44, 1st Floor, Likas Square Commercial Complex, Jalan Istiadat Likas, 88400 Kota Kinabalu, Sabah. Phone: 088235218 | WhatsApp: 0128814865 | Fax: 088245955 | Email: [email protected]