Charity Super Hero Run 2017 Registration Form
Event Timing: 6:30am, 10th December 2017
Event Address: Memorial Pengisytiharaan Kemerdekaan Bandar Hilir (A Famosa)
Contact us at:
Michael (012 - 397 6763)
Pei (014 - 386 7181)
Grey (014 - 319 9328)
Agnes (019 - 659 2988)
Aini (017 - 394 4564)
Email address *
Personal Details
Full Name (as per IC) *
Your answer
Gender *
Date of Birth: *
MM
/
DD
/
YYYY
Identity Card Number (eg: 220423-10-5987) *
Your answer
Age: *
Your answer
Contact Number: (eg: 012-3456789) *
Your answer
Occupation:
Your answer
Mailing Address:
Address 1: *
Your answer
Address 2: *
Your answer
Poscode: *
Your answer
State: *
Country: *
Event Option:
Category: *
Adult and Child T-shirt Bust Size: *
Emergency Contact:
Name: *
Your answer
Contact Number: (eg: 012-3456789) *
Your answer
Relationship: *
Your answer
Waivers: *
Required
Payment Method:
For online payment, please bank in to below account and forward the bank in slip via email as below or QR code through facebook, WhatsApp or WeChat:

Bank: OCBC Bank (Malaysia) Berhad
Account Name: MCC Industrial Systems (M) Sdn Bhd
Account No: 135 1025 616

Email: superherorun2017@gmail.com

Facebook
WhatsApp or WeChat at:
A copy of your responses will be emailed to the address you provided.
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