Organised by:

JAWATANKUASA KEMAJUAN DAN

KESELAMATAN KAMPUNG (JKKK)
KAMPUNG BUNGA, SERIAN, SARAWAK.
Enquiry:
017-3068596

Group Registration form:

CATEGORIES:-
Special Discount!!
Please tick ( √ ) on one relevant category only
( ) Men (Open) 15 KM – RM80.00 10 + 1 free slot
( ) Women (Open) 15 KM – RM80.00
( ) Men Veteran (40 years old and above) 6KM – RM70.00
( ) Women Veteran (40 years old and above) 6KM – RM70.00
( ) Boy’s Junior (17 years old and below) 6KM – RM40.00
( ) Girl’s Junior (17 years old and below) 6KM – RM40.00
( ) FUN HIKE 3KM – RM50.00
PARTICIPANT DETAILS:
Participant’s fullname (1)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (2)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (3)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (4)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (5)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (6)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname (7)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname(8)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname(9)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname(10)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
Participant’s fullname(11)
IC No/ Passport No
Date of Birth Age
Contact No: House H/phone

Permanent Address

E-mail
DECLARATION BY PARTICIPANTS & INDEMNITY
I the undersigned have read and understood the rules of competition and do hereby agree here to.
All the information particulars supplied by ourselves are true and if found false we agree that
organizers shall have the right to disqualify us from the competition.
In consideration of being permitted to compete for the events I/ We agreed to the following:
• I acknowledge that I/ We fully aware of the hazards and dangers invested in the BUNG SADUNG
CLIMBATHON CHALLENGE 2019 and hereby assume all risk involved in our participation in this
event.
• I hereby release, waive, discharge and comments not to sue the promoters, participants ,
organizers, ministry, agents, his/ her personal representatives, assigns, heirs and next of kin FOR
ANY AND ALL LOSS OR DAMAGE, ANY CLAIM OR DEMANDS THEREFORE RELATED TO THE
EVENT(S), WHETHER CAUSED BY NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
• This agreement binds me, heirs, legatee, personal representatives and all these claiming
through me.
• I/ We HEREBY AGREES TO FOLLOW ALL RULES SET FORTH IN THE BUNG SADUNG
CLIMBATHON CHALLENGE 2019 RULES, and agree to abide by any penalty(s) set by the
organizer.

(………………………………………..)
Name:______________________________
NRIC No./ Passport No. :________________________________
Date:______________________________
(For participant aged below 18 years old, must be sign by parents)