Raleigh Kuala Lumpur January 2018 Monthly Meeting
DODGEBALL ON THE TRAMPOLINE!

Date: 6 January 2018 (Saturday)
Time: 9.30am – 2.00pm
Venue: Jump Street, Petaling Jaya (Beside Jaya ONE)
Meet-up point: Asia Jaya LRT Station at 9.30am
Fee:
EARLY BIRD PRICE (before 20 December 2017) – RM40
NORMAL PRICE - RM50 for Raleigh KL members; RM55 for non-members

Email address *
Name (according to your IC) *
Eg: Sir Walter Raleigh
Your answer
IC/Passport Number *
Your answer
Contact number *
Eg: 601X-XXXXXXX
Your answer
Emergency Contact Name & Relationship *
Eg: Nat Ure & Mother
Your answer
Emergency Contact Number *
Eg: 601X-XXXXXXX
Your answer
Are you a member of Raleigh Kuala Lumpur? *
If you have paid RM30 anytime from December 2016 until now, you are a member. Otherwise, you're not a member.
Any medical conditions? *
Are you asthmatic? Have you broken any bones before? Shoulder pain? Etc? Please do let us know.
Your answer
If you're driving, would you be able to fetch some people from Asia Jaya LRT Station to Jump Street Asia, Petaling Jaya? *
AND that's the end of it! Our registration team will respond to you within 3 days upon submitting this form, and we look forward to have fun with you guys at the event!
If you have any questions for us, don't hesitate to drop us an email at monthlymeet@raleighinternational.org.my
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