Rotary Club Pudu Run

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Rotary Club Pudu Run

  1. 1. Venue : Padang Merbok, Kuala Lumpur Time : 7.30 am Online Registration : www.myraceonline.comTechnical Assistance By:
  2. 2. PUDU ROTARY CLUB Charity Run 2011 REGISTRATION FORMFull Name ( in BLOCK letters )Address ( in BLOCK letters )Postcode City / CountryNRIC No. / Passport No. Contact No.Sex ( ): M FEmail Address : …………………………………………………………………………………Category of Run (choose one) : Class Category Distance Fee please tick ( ) A Men Open (Age 15 & above) 7 KM RM 40.00 B Women Open (Age 15 & above) 7 KM RM 40.00 C Family Run (Max. 4 pax) 3 KM RM 120.00 T-SHIRT Size: Family Run (please indicate number of units): S □ M□ L □ XL □ XXL □ S □ M□ L □ XL □ XXL □Emergency Contact:Contact Name : …………………………………………………Emergency Phone No. : ………………………………………..Emergency Relationship : ………………………………………………………………………………. ………………………………Signature of Participant Date
  3. 3. IMPORTANT: IN CASE OF EMERGENCYPlease ensure that your emergency contact is reachable at any time especially on the 25th September 2011.TERMS AND CONDITIONSThe competition shall be held under the rules and regulations of the Rotary Club of Pudu Charity Run:1. Registration closing date is 11/9/2011 (Sunday) .2. Participants are required to run on the designated routes and runner’s number bib displayed at all times during the event.3. The organiser reserves the right to disqualify any participants if it is deemed that the rules were not followed.4. Registration can be made via www.myraceonline.com or submit this form together with a cheque made payable to “Pudu Rotary Club” at : c/o Jurubina Experto Sdn Bhd No. 9-1, Jalan Margosa 10/4A Bandar Sri Damansara, 52200 Kuala Lumpur (Tel:03-6273 2868 / Fax: 03-6276 0868) Monday – Friday (9.00 am – 6.00pm)5. Entries with false information will be disqualified. Late entries will not be entertained.6. Winners must be present for the prize presentation at the end of the Run, failing which the prize will be automatically forfeited.7. The organiser reserves the right to amend the rules/regulations or reschedule or change the venue of the event without prior notice.8. Once registration has been duly processed, there will be no fee refund for participants who do not eventually take part in the event for whatever reason and the registration is not transferable.9. The organiser reserves the right to use any photographs (including those of participants), motion pictures, recordings, or any other media records of the event, for any legitimate purpose including commercial advertising and distribution to the sponsors.10.There will be no fee refund if the event is cancelled for reason of force majeure i.e. due to occurrence of incidents that are beyond the control of the organiser and which renders it impossible or unsafe to hold the event.INDEMNITY CLAUSEIn consideration of the acceptance of my entry, I and my heirs, executors and administrators, release and foreverdischarge the organiser, co–organisers, and their partners, sponsors, their appointed staff and officials of all liabilities,claims, actions, damage, costs or expenses which I may have against them arising in any way connected with myparticipation in this event, including all injuries that may be suffered by me before, during and after the event. I consent toreceive and pay for any medical treatment which may be deemed advisable in the event of injury, accident and/or illnessduring the event. I understand that the aforesaid includes any claims based on negligence, action or inaction of any of theabove parties. I recognise the difficulties of the event and attest that I am physically fit to compete in the Rotary Club ofPudu Charity Run on 25th September 2011 and I have not been advised otherwise by a qualified medical professional.I hereby agree to and confirm I have read the terms and conditions and consent clause.________________________________________ _________________Signature of Participant DateAUTHORISATION BY PARENTS / GUARDIAN OF PARTICIPANT UNDER 18 YEARS OLD.This is to certify that I,___________________________________________________________________________,I/C/Passport No. __________________________________, parent / guardian (delete as applicable) of the participant,whose particulars appear above, confirm that I fully understand and accept the above and hereby agree todeclare on behalf of the participant that the Terms and Conditions and Consent Clause shall be binding on theparticipant. I hereby consent to his/her participation in the Rotary Club of Pudu Charity Run._____________________________________________ _________________Signature of Parent / Guardian of participant DatePayments: (Cheques only). Cheque No.: _____________ (All cheques must be made payable to “Pudu Rotary Club”)For online registrations, please log on to www.myraceonline.com HU UNEED ASSISTANCE?For registration queries, please call either one of the following:Mr. Tony Quay: 016.2742213 Mr. YF Chong: 012.3789575 Mr. Aaron Ong: 012-3360789 Miss Agnes Chew: 012.9100607
  4. 4. RACE KIT COLLECTIONPlease bring your registration confirmation or I/C with you.The race kit collection points and date are as follow: th17 September 2011 (10.00 am – 6.00pm)Sri Damansarara Club HouseLot 23304, Persiaran PerdanaBandar Sri Damansara52200 Kuala LumpurTel. : 603-6272 8888 th24 September 2011 (10.00 am – 7.00 pm)Padang Merbok, Kuala Lumpur thREPORTING TIME ON RACE DAY (25 September, 2011) : 6.30 AM

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