Starwalk Ipoh 2014

Registration Form

Full Name
I.C / Passport No
(Without the "-")
Address
 
 
Post Code
City
State
Tel No.
Mobile No.
Email
Date of Birth
Age
Marital Status
Single Married
Gender
Male Female
Race  
Nationality
Occupation  
Closing Date:
May 30, 2014 (Friday) or 15,000 entries (whichever is earlier)
I wish to participate in the following event:

RM 12 for Non-Competition Walkers

 
  M Men
  F Women

  To The Organisers, Ipoh Starwalk 2014
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 Ipoh 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 the 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 Ipoh Starwalk.
 
Name I/C No
Contact No
 
 
Ipoh Starwalk Logo
For more information please call 05-253 0402 or visit our Facebook page http://www.facebook.com/StarWalk.my