REGISTRATION FORM + map

ORGANIZED BY :
LIONS CLUB OF ALOR STAR (HOST)
SUPPORTED BY :
ALOR SETAR LM BIKERS
BELIA DAN SUKAN
ALOR SETAR JOGGING CLUB
JUNIOR CHAMBER INTERNATIONAL ALOR SETAR
3RDCYCLE FOR HEALTH & ENVIRONMENT
FRIDAY 16TH SEPTEMBER 2011 AT KOMPLEKS BELIA DAN SUKAN NEGERI KEDAH, ALOR SETAR, KEDAH DARUL AMAN.
1) Purposes
: - To promote cycling as a healthy life style.
- To create awareness of environment conservation.
- The event is a fellowship Ride (not a race)
2) Registration
: All registration form should be submitted before 01.08.2011.
3) Entry Fee
: RM30.00 ( Entitled for a T-shirt, lunch pack & lucky draw)
4) Distance
: ≈ 51.5 Km.
5) Preparation
: All participants are strongly advised to bring along your own safety helmet,
hand glove, cycling attire and a road-worthy mountain bike.
All participants are required to wear the event T-shirt during the ride.
(strictly NO HELMET, NO RIDE)
6) Rest / Feeding Point
: 30.5km at Museum Padi
7) Disclaimer
: The organisers shall not be held responsible and liable for any injuries, death, loss, damages,
expenses and any other liabilities suffered and sustained by any person, including but not limiting
to the Participant due to the Participant and/or the Organisers' negligence or fault or any other
reasons whatsoever.
8) Other
: The organisers reserve the right for any amendment
and last minute postponement/cancellation of the event.
th
Participants can collect their T-Shirt etc on 15 September 2011 from 2.00pm until 6.00pm
at Kompleks Belia Dan Sukan Negeri Kedah, Jalan Stadium, Alor Setar.
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REGISTRATION FORM
PERSONAL INFORMATION
NAME
: _________________________________________________________________
ADDREES
: _________________________________________________________________
IC /PASSPORT NO
: _______________________________________________________________________
H/PHONE NO
: _____________________________
AGE
: _______________________________________________________________________
NATIONALITY
: _____________________________
EMAIL
: _______________________________________________________________________
DATE OF BIRTH : _____________________________
GENDER
: MALE
T-SHIRT SIZE
: S
FEMALE
M
L
XL
XXL
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------IN CASE OF EMERGENCY CONTACT
CONTACT PERSON
: _________________________________________________________________
CONTACT NO.
: _______________________________________________________________________
RELATIONSHIP : _____________________________
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------FOR PARTICIPANTS UNDER 18 YEARS OF AGE
PARENT'S/GUARDIAN'S NAME
: _______________________________________________________________________
PARENT'S/GUARDIAN'S I/C : _____________________________
PARENT'S/GUARDIAN'S SIGNATURE
: _______________________________________________________________________
DATE
: _____________________________
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------CONDITION OF ENTRY; RULES AND REGULATIONS FOR THE "3RD CYCLE FOR HEALTH & ENVIRONMENT FRIDAY 16TH SEPTEMBER 2011
1) Flag Off for the event at 7.00 am. Please ensure that are you present 30 minutes before the allocated time.
2) Participation is open to those 12 years and above and those below 18 years must get consent from parents(s)/guardian(s).
3) All participants and working committee who are involved in this event MUST ensure there is no rubbish thrown along the entire route and the
starting/finishing point for the event (KEEP GREEN).
4) Participants may also download Registration Form from http://www.facebook.com/pages/ALOR-SETAR-LM-BIKERS/356544859505 or
lmbikers.4umer.com. Please bank-in Entry Fee of RM 30.00 to Lions Club Of Alor Star (Host), Public Bank Account No:3139400227,
please fax both the Registration Form and Bank Slip to 04-7142413, or scan and email to [email protected].
5) Person to Contact
Media Support :-
: Ong Lee Hoon (019-444 6024), Chong Soon Huat (019-440 5191), Loh Hooi Hong (012-578 7811),
Fong Chan Hap (012-431 6855), Khaw Eng Soon (012-494 3283) or En Zamzuri (012-423 3667).