Download Registration Form

Event Registration Form
Merdeka
12 Hour
MTBRide
Endurance
Grande Road
Charity
2015
Venue:Bukit
Meru,
Ipoh,Laketown
Perak. Resort, Taiping
Venue:
Merah
Date: 08 February 2015.
Organizer: Lions Club Of Ipoh Evergreen.
Website: www.grcr15.cyclingevents.my
Registration Closing Date: 01 January 2015.
Registration Instruction
1. Print out and complete this registration form, including the CyclingEvents.my user registration section. Make sure
that you read the terms and conditions, description and/or requirement for each category on the website clearly
before you register for the event.
2. Prepare participant fees according to the number of participants and fees for each category, then make payment
to the following bank account:
Account Name:
Acc Number:
SPORTS EVENTS HOUSE SDN BHD
8007-119579
3. Submit your completed registration form together with the proof of payment via the following method:
(a) E-mail: [email protected]
(b) Fax: 03 - 7497 3227
(c) Whatsapp / Wechat: 018 - 288 2960 (Shaun)
4. After the submission of your registration, You will receive an email with your user login details to
CyclingEvents.my. Use this login to retrieve your Event Itinerary when you payment has been confirmed.
5. Once your payment has been confirmed, you will receive an email to notify your event registration to be
successful. You can now login to CyclingEvents.my to retrieve your Event Itinerary.
6. Print out the event itinerary and present to the organizer during goodie collection on the event day.
Note:
We practice the first-come, first-served policy and no reservation is available. Your registration will only
be confirmed once payment is received. To avoid disappointment, kindly make payment together with
your registration submission.
Contact Us
Organizer:
Nicholas Tham:
011-28311554
Boo Jun Fui:
012-5558503
Registration Partner:
Sports Events House Sdn Bhd: 03 - 7497 3227 (Office hours only)
Shaun: 018 - 2882 960 (Whatsapp, WeChat, SMS)
Matters related to event registration, retrieving your itinerary, changing your participant details, and etc.
CyclingEvents.my User Account Registration
You will use this account to retrieve your event itinerary, change booking details, and register for other future events.
Name as per NRIC:
Gender:
Contact No:
Email Address:
NRIC / Passport:
1
Category
A - General Entry
Fees: RM 50.00 per participant
For male and female above 18 years old
B - Under 18 Entry
Fees: RM 50.00 per participant
For male and female below 18 years old
Registration - General Entry
1. This form is for both Individual and Group Registration.
2. For T-Shirt Size, there are 12 sizes in total - 5XS, 4XS, 3XS, 2XS, XS, XS, S, M, L, XL, 2XL, 3XL, 4XL.
3. If there is not enough space for more participants, kindly print out another sheet to fill in.
Team Name: (optional)
Team Leader / E. Contact Person Name:
Gender:
Email Address:
No.
eg:
Contact No:
Participant Name
NRIC/Passport No.
E-mail Address
Ali bin Abu
000000-00-0000
[email protected]
Contact No
000-0000000
T-Shirt Size
XXL
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Event Terms & Conditions
- I declare that I am deemed physically fit and medically fit to participate in this event.
- I will not request for a refund in the case of my withdrawal of participation in the event.
- I agree not to hold the Organizer and Co-organizers, against all cost, expense or liability that may arise in
consequence of my participation in the event
- I waive all claims for any and all injuries, death and invalidity to me or the person under my care which may be
caused by any act, or failure to act by the Organizer and Co-organizer, members and employees arising directly or
indirectly during the course of event or arising as a result of it.
Signed By:
2
Registration - Under 18 Entry
1 This form is for both Individual and Group Registration.
2 For T-Shirt Size, there are 12 sizes in total - 5XS, 4XS, 3XS, 2XS, XS, XS, S, M, L, XL, 2XL, 3XL, 4XL.
3 If there is not enough space for more participants, kindly print out another sheet to fill in.
No.
Participant Name
NRIC/Passport No.
E-mail Address
Contact No
T-Shirt Size
1
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
2
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
3
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
4
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
5
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
6
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
7
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
8
Parent/ Guardian name
NRIC / Passport No.
I hereby give permission for the participant above to participate in this event. (Please tick the box)
Event Terms & Conditions
- I declare that I am deemed physically fit and medically fit to participate in this event.
- I will not request for a refund in the case of my withdrawal of participation in the event.
- I agree not to hold the Organizer and Co-organizers, against all cost, expense or liability that may arise in
consequence of my participation in the event
- I waive all claims for any and all injuries, death and invalidity to me or the person under my care which may be
caused by any act, or failure to act by the Organizer and Co-organizer, members and employees arising directly or
indirectly during the course of event or arising as a result of it.
Signed By:
3

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