REGISTRATION FORM

Paintball Robot

Competition :

Category : (Please Tick)

University

Technical & Skills Institution

Name of Institute of Higher

Learning
Tel No. (office)

Fax No. (office)

Team Name
Team Managers Name
(staff only)
Mobile No.

Email

IC /Passport No.

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

Coordinators Name
(staff or student)
Mobile No.

Email

IC /Passport No.

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

Operator 1 Name
(student only)
IC /Passport No.

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

Operator 2 Name
(student only)
IC /Passport No.

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

Operator 3 Name
(student only)
IC /Passport No.

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

Pit Crew 1 Name

(student only)
IC /Passport No.

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

Pit Crew 2 Name

(student only)
IC /Passport No.

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

Pit Crew 3 Name

(student only)
IC /Passport No.

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

Poster Presenters Name

((student only)
IC /Passport No.

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

Members of a team: 1 manager, 1 coordinator, 3 operators, 3 pit crews & 1 poster presenter
Note:
1. Please email this form to muroc@unimap.edu.my or fax to +604-985 2232
(attn : Cik Norharnila Rusli)
2. Poster presenter can represent one or more category(s) from the same
institution.

3.
4.
5.

Total fee (University)

Total fee (T&S Institution)

RM 650.00 / USD 250

RM 450.00

The members listed in this form are final and not subjected to any changes.
Coordinator (if the coordinator is a student) can also be the operator or pit
crew or poster presenter at the same time.
Registration deadline : 25th January 2014. Payment must be made before
the deadline by cheque, local/purchase order, bank in, or TT transfer.

Confirmed by,

(Team Managers Signature & Stamp)

Please bring along this form together with students matrix/ID card upon final registration on 11th April 2014.

(Date)