Preah Vihear Temple Run 2017
First Name/នាមត្រកូល
Last Name/ ឈ្មោះ
Age/
Gender/
Nationality/
Email/អ៊ីម៉ែល
Phone number/លេខទូរស័ព្ទ
Emergency Contact/ លេខអាណាព្យាបាល
Emergency Name/
Race Category For Foreigner
Camping/Meal/Bus Service
តារាងរត់សម្រាប់ខ្មែរ
សេវាកម្មជួល តង់/អាហារ/រថយន្ដ
T-Shirt Size/ទំហំអាវ
Declaration/ទំនួលខុសត្រូវ
I certify that I am medically fit to compete and fully understand that I enter at my own risk and other organizers will no way be held responsible for any injury, illness of loss, during or as a result of the event.
រាល់បញ្ហាដែលកើតមានឡើងក្នុងពេលកម្មវិធី ខ្ញុំសូមទទួលខុសត្រូវដោយខ្លួនឯង និង មិនអោយអ្នករៀបចំកម្មវិធីទទួលខុសត្រូវឡើយ។
Where did you hear this event from? តើអ្នកបានដឹងព័ត៌មាននេះពីណាដែរ?
Payment with/បង់លុយតាម
ACLEDA Bank Plc. - Cambodia : Account Name: Active Sport
Account No: 3473-02230809-1-9


Remark:
-You will be registered immediately upon we had received the payment in our bank account and please send us the bank slip of payment after you transferred it to (direct@activesport.com.kh)
-The bank charges insured by transfer must be paid by the participants.
-Entry fees are not deducted from amount remitted.

Contact Us/ ទំនាក់ទំនង
Online Registration:
Mr. Muy Lath: 077 62 77 91/016 62 87 88, E-mail: direct@activesport.com.kh
Mr. Sopheap: 086 62 87 88/ 012 96 00 28 E-mail: timer@activesport.com.kh,
www.activesport.com.kh
Like Us On Facebook /កុំភ្លេច Like Us On Facebook ដើម្បីទទួលបានកម្មវិធីថ្មីៗ
Note/ ចំំណាំ
- Make sure you have free time to join this event.
- Don't fill this form if you not sure to join.
- Don't make our form have a problem when you fill this form it will save to our database.

- ត្រូវប្រាកដថាអ្នកមានពេលសម្រាប់ចូលរួមកម្មវិធីនេះ។
- មិនត្រូវបំពេញបែបបទរត់ដោយមិនប្រាកដចិត្ត និង ចង់បំពេញលេង
- មិនត្រូវធ្វើការរំខានអោយខូចខាតប្រព័ន្ធគ្រប់គ្រងទិន្នន័យរបស់យើង

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