Pharm Run Melaka 2018
Date: 29 September 2018
Venue: Padang Kawad Ibu Pejabat Polis Daerah Jasin, Melaka Malaysia
Google map : https://goo.gl/maps/vmfctsqrvb52
Distance: 4km
Fee per Pax: RM 50.00
Flag Off Time: 7.30 pagi
Email address *
Registration is open until 15 OGOS 2018
Name (As per IC/Passport) *
IC Number (As 87XXXX-01-XXXX) *
Address *
State *
Poscode *
Phone Number (as 01X-XXXXXXX) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Participants Entitlement
Goodies bag consist of : Ultron microfiber T-Shirt, Medal, Ultron Drawstring Beg, Certificate and Bib
Medal Design
Drawstring Bag design
T-shirt design
Chart Size
T-shirt Size *
Emergency Contact Person *
Emergency Contact Number (As 01X-XXXXXX) *
Race-Kit Collection (TBA)
Waiver and T&C
I hereby agree *
Required
Payment
Please make your payment through our bank details below

Bank Name: CIMB BANK BERHAD
Acc No: 8004-6686-63
Acc Name: MALAYSIAN PHARMACEUTICAL SOCIETY MELAKA AREA COMMITTEE
Ref 1: Pharm Run
Ref 2: IC Number

Please upload the bank-in / transfer slip here: *
Required
Contact Person
Liayana 019-677 4695
Diniah 019 – 677 4680
Syuhada 019 - 6774676
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