borang kumpulan mtb jamboree

Uitm
PAHANG
MOUNTAIN
BIKE
JAMBOREE
50.020
M
R
:
Fee 20 April 201
n
o
i
t
a
te :
tr
Regis Closing Da
_
12 - 13 MAY 2012 - 45 KM +
An Open Invitation To All Mountain Bikers
GROUP REGISTRATION FORM
Group Name
:
Person in Charge
:
Contact No
:
Email
:
Bil
Name
No. KP
Phone No
M/F
Size
Category
Open IPTA/S
** Note **
- Only one representative form the team is required to collect the goodies
- Fees for the ride RM 50.00 ( Before 20 / 04 / 2012 ) after closing date RM 35.00 ( No T-shirt )
- Goodies collection ( 12 May 2012 at Dataran Intergrasi UiTM Cawangan Pahang ( 10.00 - 23.59 )
Bank-in account info :
Affin Bank Bhd ( 10513 00 00 095 ) UiTM Pahang
Cheque : Pengarah Kampus UiTM Pahang
Contact Person : Dr. Wan Mohd Nazri - 019 9317230
YM. R.N. Welldone - 013 9494465
En. Nazrie
- 013 9324110
Legal Noticed & Disclaimer
I hereby declare that i have read and fully understood the term and condition of participant in the event and i participated in the event at my own
risk without any comment, i hereby confirm my health condition acceptance of the term and condition and have no waive to claim to the organizer,
their member, employees, agents or such either participant involved whatever directly or individual in the participant.
.....................................................................
Person In-Charge :
Date :
Uitm
PAHANG
MOUNTAIN
BIKE
JAMBOREE
50.020
M
R
:
Fee 20 April 201
n
o
i
t
a
te :
tr
Regis Closing Da
_
12 - 13 MAY 2012 - 45 KM +
An Open Invitation To All Mountain Bikers
GROUP REGISTRATION FORM
Group Name
:
Person in Charge
:
Contact No
:
Email
:
Bil
Name
No. KP
Phone No
M/F
Size
Category
Open IPTA/S
** Note **
- Only one representative form the team is required to collect the goodies
- Fees for the ride RM 50.00 ( Before 20 / 04 / 2012 ) after closing date RM 35.00 ( No T-shirt )
- Goodies collection ( 12 May 2012 at Dataran Intergrasi UiTM Cawangan Pahang ( 10.00 - 23.59 )
Bank-in account info :
Affin Bank Bhd ( 10513 00 00 095 ) UiTM Pahang
Cheque : Pengarah Kampus UiTM Pahang
Contact Person : Dr. Wan Mohd Nazri - 019 9317230
YM. R.N. Welldone - 013 9494465
En. Nazrie
- 013 9324110
Legal Noticed & Disclaimer
I hereby declare that i have read and fully understood the term and condition of participant in the event and i participated in the event at my own
risk without any comment, i hereby confirm my health condition acceptance of the term and condition and have no waive to claim to the organizer,
their member, employees, agents or such either participant involved whatever directly or individual in the participant.
.....................................................................
Person In-Charge :
Date :