KAYUHAN WARISAN TAIPING 2009

Date : 27 Disember 2009 LIMITED 500

Flag Off : 7.30 am (sharp) PARTICIPANT
Venue : Kompleks Rakan Muda, Kamunting
REGISTRATION FEE : RM 50.00 BANK IN TO: CIMB BANK - 08040090339522
K-RAITT MTB CLUB

STEP: FAX YOUR SUBMISSION TO: 05-8078848

 Bank in your money to the A/C
 Fax your bank slip with name, IC no, and jersey size.
GOODIES COLLECTION: 26 DISEMBER 2009
For bulk registration pls. fax complete name list with i.c no.
12noon – 12.00 PM
and JERSEY size.
Kompleks Rakan Muda, Kamunting
 Check name list at
http://kayuhanwarisantaiping2009.blogspot.com
Contact person: PN. SURYANI : 019 – 478 1370
 Bring along the original registration form and bank slip/ EN. SHAIFUL : 019 – 511 8088
receipt goodies collection day. EN. SHAFIZ : 019 – 644 6708

Name : __________________________________________________ Gender: Male / Female

Address : __________________________________________________________________________
__________________________________________________________________________
IC No : ________________________________ Tel & Mobile: ____________________________
Email : _________________________________
Club/ Team & Location: ________________________________
Emergency Contact (Name & Tel No.): ___________________________________________________

JERSEY SIZE : S / M / L / XL / XXL (Please circle)

LEGAL NOTICE AND DISCLAIMER

Participation in the event is at participant’s own risk
The participant hereby declares warrants and represents to the Organizers that the participant is 18 years or above. (Participant below the age of
18 is required to complete the Parental Consent section provided above).
As a matter of caution, the participant ought to:
1. Have sought medical examination to ensure that the Participant is certified to be medically fit to participate in the Event.
2. Wherever applicable have ought to ensure that the Participant insurance policy is not void or voidable as result of the Participant’s participation
in the Event.
3. Have ensure that the Participants sporting equipment and safety gears have been recently examined by a skilled bicycle mechanic and Event
services and certified to be fit for use in such an Event.
4. Have taken cognizance of the fact that the trail designated for this event is extremely challenging and hence requiring much endurance and
technical skill to surmount.

I HEREBY DECLARE that I have read and fully understood the terms and conditions of participants in the event and participate in the Event at my
own accord without any duress and I hereby confirm my unconditional acceptance of the terms and conditions of participation and hereby waive
any right of claim against the Organizers, their members, employees, agents or such other parties involved whether directly or indirectly in the
preparation organization and / or management of ‘KAYUHAN WARISAN TAIPING 2009’.

Yours truly,

---------------------------------
SIGNATURE & DATE

FOR PARTICIPANT BELOW 18 YEARS OLD

I, ___________________________ father/mother/legal guardian hereby acknowledge that I have read and fully understood the terms the
conditions of participation in the Event and hereby consent to Kayuhan Warisan Taiping 2009 participation in the Event and hereby waive any right
of claims against the Organizer, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation,
organization and / or management of ‘Kayuhan Warisan Taiping 2009’.

Signature of parent / Guardian & I/C No. Organized by

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FOR ORGANIZER USE UNPAID PENDING PAID

FORM RECEIVED BY : PAYMENT STATUS :
DATE & TIME RECEIVED: CHEQUE/PAYMENT SLIP No:
PARTICIPANT NO : PAYMENT DATE :
REMARKs : RECEIPT ISSUED BY :
RECEIPT No & DATE :