WORLD KIDNEY DAY DANCE MARATHON 2014

16 March 2014
WORLD KIDNEY DAY DANCE MARATHON 2014
1 UTAMA Shopping Centre / 16 March 2014 / 9am – 1pm
The Dance Marathon 2014 organized by the National Kidney Foundation of Malaysia (NKF) in conjunction with
World Kidney Day 2014 is an event in which 500 participants will be dancing together from 9.00 am – 1.00 pm in
the concourse of the “1 Utama” Shopping Centre. Professional dancers from the famous “Celebrity Fitness”
gymnasium will be leading the participants.
The objective of this event is to encourage members of the public to come forward to exercise through dancing
and to do it for a good cause i.e. to raise funds for poor kidney failure patients under the care of NKF.
There will be no winners for this event. This event is to raise funds as well as to create an awareness and
educate the public on kidney disease. We want everyone to come forward to exercise, sweat and have fun!
There will be lucky draw prizes and every participant will be eligible for the draw.
Entry Form
Date
: 16 March 2014, Sunday
Time
: 9.00am to 1.00pm
Venue
: 1 Utama Shopping Centre
1, Lebuh Bandar Utama, Bandar Utama City Centre
Bandar Utama, 47800 Petaling Jaya,
Selangor Darul Ehsan, Malaysia
Registration Fee : RM30
*For participants under 18 years old, consent as perform below form is required.
Full Name of Participant
:
………………………………………………………………………………………………….
Email
:
……………………………………………………………………………………..…………..
NRIC No/Passport No
:
………………………………………...
Date of Birth
: ………..............…....
Age
:
…………….…….….......................
Gender
:
Telephone No
:
………………….….........................
Contact No
: ........................................
Address
:
......................................................................................................................................
Male
Female
…………………………………………………………………………………………………
City
:
……………………………….....
State
:
Postcode
:
……………………….
Nationality :
…………………………….
..........................................
T-shirt Size:
Size
Chest
S
M
L
XL
XXL
37”- 39”
39”- 41”
41”- 43”
43”- 45”
45”- 47”
Adult Size
Length
Mark
()
24.5”- 25.5”
25.5”- 26.5”
26.5”- 27.5”
27.5”- 28.5”
28.5”- 29.5”
Size
S
M
L
Kid Size
Chest
Length
29”
31”
33”
Mark
()
18.5”
20”
21.5”
*Please note sizes are limited.
Emergency Contact
:
Contact Person’s Name
: ……………………………………………………………………………………………………………..
Contact No
: …………………………………………
Relationship
: ………………………...............
Medical Conditions if any : ……………………………………………………………………………………………………………..
WAIVER CLAUSE.
FOR PARTICIPANTS UNDER 18 YEARS OF AGE
I am aware of and accept the risks of participating in the
dance marathon.
In consideration of the acceptance of my entry, I , my heirs,
successors and assigns, do hereby unconditionally waive and
release the organizer, this dance marathon event sponsors
and all persons and agencies connected with it from all claims
and damages whatsoever, that may arise from my
participation in this event, including without any limitation,
personal injury. I also give full permission for use of my
photograph in connection with this event for any legitimate
purpose including distribution to sponsor and publications of
the organiser.
I hereby consent to my child/ward participating in the
WKDDM 2014. I have read and agreed to the Rules and
Regulations of WKDDM 2014 which states that the participant
will dance at his/her own risk and organiser will not be held
responsible or liable for any injury or death howsoever arising
from training for or during participation in the dance marathon.
…………………………………………
Participant’s Signature
..................................................
(Parents/Guardians Signature)
Full Name : ……………………………………………….
NRIC No. / Passport No. : ………………………………………
Relationship:
Father
Mother
Guardian
Registration and Payment
All registrations and payments are to be made before or on 3rd March 2014, Monday
Payment
:
Cheque payable to National Kidney Foundation of Malaysia
Cash Deposit in to 0140 8433 4846 (Maybank)
(Please forward the payment slip together with this entry form to the following address or fax number)
National Kidney Foundation of Malaysia
NKF-Berjaya Resource Centre,
72 Jalan 14/29, 46100 Petaling Jaya, Selangor Darul Ehsan.
For online registration, please log onto http://www.simplygiving.com/event/WKDDanceMarathon2014 where RM2.00 per
transaction will be charged.
Contact person:
Wan Li Yin
Tel: +60 3 7954 9048 ext. 225
Fax:+60 3 7958 8215
Email: [email protected]
Mazhani bt Azhan
Tel: +60 3 7954 9048 ext. 215
Fax:+60 3 7958 8215
Email: [email protected]
*No refunds will be entertained.
Dance Kit Information
Dance Kit consists of
Venue
Collection Dates
Time
: WKD2014 T-shirt and Coupons for goody bag & snacks
: NKF – Berjaya Resources Centre
72, Jalan 14/29, 46100 Petaling Jaya, Selangor Darul Ehsan
: 8th and 9th March 2014 (Saturday and Sunday)
: 10.00am – 6.00pm
*Please note uncollected dance kits after collection dates will be deemed as property of the organiser who reserves the right to
dispose off or re-distribute them as they deem fit.
*There will be NO distribution of dance kits on the event day.
*Whilst every reasonable precaution will be taken by the organizer to ensure the participants safety, participants are strongly
encouraged to go for a medical examination and/or consult their medical practitioner prior to registration and before the actual
dance marathon day.
General Enquiries
For any general enquiries pertaining to the World Kidney Day Dance Marathon 2014, please contact:
Wan Li Yin
Mazhani bt Azhan
Tel: +60 3 7954 9048 ext. 225
Tel: +60 3 7954 9048 ext. 215
Fax:+60 3 7958 8215
Fax:+60 3 7958 8215
Email: [email protected]
Email: [email protected]
Registration Closing Date:
Monday 3rd March 2014 or upon reaching the maximum of 500 participants.
*No registration will be entertained on the event day.

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