Group Form

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Group Name :

Registration Date Participant:1. 2. 3. 4. 5. Name :_____________________________________ Name:_____________________________________ Name :_____________________________________ Name :_____________________________________ Name:______________________________________ :

PAYMENT (FOR OFFICE USE ONLY)


Total Charges Receipt No. Payment Method : : :

CONTACT PERSON :
Name :

Tel / Hp : Email :

Address :

ENTRY FEES : RM 150/ per team

We wish to participate in the Exhibition All equipment for Exhibition to be prepared by Exhibiter

CONTACT US
Email : sabah@suhakam.org.my Tel: +6(088)-317405

WAIVER I certify that I am medically fit to compete and fully understand that I enter at my own risk and the organizers will in no way be held responsible for any injury or illness, during or as result of the event.

Office Address: SUHAKAM Sabah, Suite E1&W1, 8th Floor, CPS Tower, No. 1, Jalan Centre Point, 88000 Kota Kinabalu.

Runner Number Name

Gender (M/F)

Date of Birth

Passport/IC No.

T-Shirt Size (S,M,L,XL,XXL)

Relay Run Photos RM10 each to be sent via email only (rapidshutterinc.net)

Waiver (Please see statement overleaf)

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