Couple Run 2016
Registration Form
22th October 2016 ( SATURDAY )
Full Name as per IC ( Male)
Your answer
Contact Number ( Male)
Your answer
Shirt Size ( Male)
Emergency Contact Number ( Male)
Your answer
Full Name as per IC ( Female)
Your answer
Contact Number ( Female)
Your answer
Shirt Size ( Female)
Emergency Contact Number ( Female)
Your answer
I accept all of the rules and regulations stated below
I hereby agree to abide the rule and regulation of the couple run. I certify that the particulars are correct and I am physically fit and sufficiently trained to participate in the Couple Run 2016. In consideration of the acceptance of my entry, I release and forever discharge the organizer and all those involved with the organization of this Couple Run 2016 of all liabilities, claims, actions, damages, cost and expenses, which I may have the against them arising out of in any way connected with my participation in this event, including all injuries that may be suffered by me before, during or after the event.
Required
Payment Summary
12th October 2016
2 people be a pair, must be a male and a female
The payment for the early bird pairs must be made before 20th September 2016
Normal RM 90/pair
Member RM 85/pair ( either one has BIZ YIC membership card is enough )

Payment can be made by bank in the money to

CIMB Bank
ONG ZONG YAO
7024004461

REMEMBER TO
Send the receipt by WhatsApp +6012-6859496
P/s: State down your name on the receipt.

Thank you for joining and good lucks :)

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