4th MBPJ INLINE HOCKEY TOURNAMENT 2012 - MIHT12 31st August & 1st September 2012, Selangor, Malaysia.

OPEN CATEGORY REGISTRATION FORM: TEAM NAME: COUNTRY/ STATE: CONTACT PERSON: E-MAIL: NUMBER OF PLAYERS: No. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Mark beside name: (GK) Goal Keeper (C) Captain (A) Assistant Captain Player Name DATE: Jersey Number Age IC/Passport No. TEL:

By participating in MIHT12, 4th Inline Hockey Tournament 2012, 31st August & 1st September 2012, the above team players may be participating in activities that may involve an above average element of risk, in an environment and accidents and injuries may arise. It is your responsibility to ensure that you team fully understands the exact nature of this sport that they will undertake, the risks involved, the skill levels required, & the equipment needed for your safe participation. All team players should never participate in an activity where you are unsure of any of the above aspects. If in doubt, ask any of the MIHT Committee members or the MIHT Organiser(s) for the further information. I/we hereby agree and will abide on the rules and regulations of the 4th MBPJ Inline Hockey Tournament 2012 Rulebook. I/we agree to act in accordance with the Activity Constitution & Code of Practice & Risk Assessments. I/we have read, understood & agree to act in accordance with the above statement.

I ___________________representing Team ____________, we hereby agree to have read, understood & agree to act in accordance with the above statements. We agree on the Registration Fees of RM400 per team. We will continue to maintain and uphold great sportsmanship and honor in the name of this great game.

____________________ Signature ___________________ Received by

RM___________________ PAID Date: ( )

Date: (

mihtmalaysia@gmail.com / Fax: +603 7710 1119. For further inquiries & payment, kindly contact: Craig Lee (Malaysia) +6012 202 3597 Lily Hamid (Singapore) +6596902661

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