Karnival Kayuhan Amal

Anjuran

ADUN Kuala Nerang dan Agro Bank

Tarikh : 16 JULAI 2011 (SABTU) Flag Off : 7:45 PAGI Venue : MEDAN KUALA NERANG

REGISTRATION FEE

RM10.00

Urusetia: Tuan Rozali: 0199752672 Anis : 0195682554 Cikgu Fauzi: 0194287117 Megat: 0179021993 Lan: 0194776230

STEP: Borang dan wang pendaftaran boleh diserahkan di Pejabat ADUN Kuala Nerang. Penyertaan terhad kepada 100 peserta pertama sahaja. Semua peserta diwajibkan memakai helmet basikal.

TARIKH TUTUP PENDAFTARAN: 10 Julai 2011

Name : Address : IC No. : Tel & Mobile : Emergency Contact (Name & Tel No.) : LEGAL NOTICE AND DISCLAIMER Participation in the event is at participants 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 below). 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 Participants insurance policy is not void or voidable as result of the Participants participation in the Event; 3. Have ensure that the Participants sporting equipments and safety gears have been recently examined by a skilled bicycle mechanic and 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 participant 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 Karnival Kayuhan Amal 2011 Yours truly,

Gender : Male / Female

E-mail : Club/Team & Location :

SIGNATURE & DATE FOR PARTICIPANT BELOW 18 YEARS OLD

, 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 of participation in the Event and hereby waive any right of claim against the Organizer, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation, organization and / or management of Karnival Kayuhan Amal 2011 I,

Signature of Parent / Guardian & I/C No.

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