Participation Form Competition Route Non-Competition Route Ipoh Starwalk on Facebook

Registration Form

Full Name

I.C / Passport No
(Without the "-")

Address

Post Code

City

State

Tel No.

Mobile No.

Date of Birth

Age

Marital Status

Single

Married

Gender

Male

Female

Race

Nationality

Occupation

Closing Date:
May 17, 2013 (Competition Category),
May 31, 2013 (Non-Competition Category) or once the 17,000 mark is reached, whichever is sooner.

*Entries for competition category is open to a maximum of 2,000 participants.

I wish to participate in the following event:

RM 10 for Non-Competition Walkers

	M	Men
	F	Women

RM 15 for Competition Walkers [ CLOSED ]

- Winners in respective categories will be entitled to individual prizes. All successful competitors who complete the walk within the prescribed time limit will be entitled to a participation certificate and to participate in a lucky contest.

	A	Boys (13 years to 19 years)
	B	Men (20 years to 39 years)
	C	Men Junior Veteran (40 years to 49 years)
	D	Men Senior Veteran (50 years to 59 years)
	E	Men Diamond Veteran (60 years and above) **

	G	Girls (13 years to 19 years)
	H	Women (20 years to 39 years)
	J	Women Veteran (40 years to 49 years)
	K	Women Senior Veteran (50 years and above) **
	**	If less than 50 (fifty) entries were received at closing date, the organisers reserve the right to re-categorise the said participant to Men Senior Veteran/Women Veteran respectively.

RM 20 for Competition Walkers (International)

	MI	Men (20 years and above)
	WI	Women (20 years and above)

(All successful competitors who complete the walk within the prescribed time limit will be entitled to a participation certificate and to participate in a lucky contest.)

To The Organisers, Starwalk Ipoh

I agree to abide by the conditions and rules of the Walk. I declare that the details given are correct and I am physically fit and sufficiently trained to finish the Walk. I will attempt to complete the Walk within the time limit.

ATHLETES: WAIVER/INDEMNITY:

In consideration of the Organiser accepting this entry, I upon entry and registration to participate in the above Starwalk, hereby for myself, my heirs, executors and administrators, waive and release any and all rights or claims to damages I may have against the Organisers holding this Starwalk, their agents, representatives, successors, assignees, sponsors and co-sponsors for any and all injuries, death and invalidity I may sustain during the course of the event or arising as a result of it.

I hereby indemnify you and keep you indemnified and waived against all claims or damage that arise in consequence of the above.

FOR PARTICIPANTS UNDER 18 YEARS OF AGE

I parent/guardian of the participant, whose particulars appear above, confirm, that I fully understand and appreciate the effect of the above waiver and hereby agree and declare on behalf of the participant that the purport of the waiver clause will have equal binding effect on the participant.

I hereby consent to his/her participation in the above Starwalk

Name		I/C No
Contact No