Raleigh Kuala Lumpur July 2018 Monthly Meeting
Date: 22/7/2018 (sunday)
Time: 8.00am - 2:30pm
Venue: Bukit Kiara Properties gallery (BKP) VERVE Suites KL South

Fees: A minimum purchase of 1 booklet @ RM10

You can join the charity event as a
a) Join the charity event as participants. You are required to be there by 8:00am, but not required to stay until 3pm.
b) Join volunteer at the game booths. You are required to be there before 8:45am and will assist based on schedule.

Email address *
Name (according to your IC) *
Eg: Tunku Abdul Rahman
Your answer
IC/Passport Number *
Eg: 951021-XX-XXXX
Your answer
Gender *
Contact number *
Eg: 601X-XXXXXXX
Your answer
Emergency Contact Name *
Eg: Muhamed Ali
Your answer
Emergency Contact Relationship *
Eg: Father
Your answer
Emergency Contact Number *
Eg: 601X-XXXXXXX
Your answer
Are you a member of Raleigh Kuala Lumpur? *
If you have paid RM30(first sign up) or RM20((member renewal) anytime from Aug 2017, you are a member. Otherwise, you're not a member.
Please state you interested to join as what role during the event. *
How many booklet that u wish to buy ? (1 booklet = RM10) *
Any medical conditions? *
Do you have any existing medical condition, physical or mental, that we should be aware about in case of any emergency?
Do you have any allergy? *
Indemnity Form
IN CONSIDERATION OF, and as part of the agreement for the opportunity to participate in the activity, the activities arranged by Raleigh International Kuala Lumpur (hereinafter referred to as “RIKL”), I hereby agree:

1. I acknowledge I have read, understood and approved the following terms and conditions.

2. I am aware that certain activities involve inherent risks of illness, injury, death and/or loss or damage of property, which may be caused by negligence, forces of nature and other causes known or unknown. I recognize that such risks are present always, before, during and after the activity. I am also aware that medical facilities may not be readily available during the activity.

3. I hereby indemnify and irrevocably and forever release and waive all rights and recourse against RIKL and their respective subsidiaries, licensees, successors, related and affiliated companies and their officers, directors, employees, contractors, agents, representatives and assigns, from and against any and all claims, demands, payments, proceedings, judgments, settlements, awards, expenses (including without limitation, legal fees and costs) damages, losses, costs, injury (however caused), death, illness, delay or other liabilities, which I or my heirs, executors, administrators or personal representatives now have or hereafter can, shall or may have against any of the above-named entities arising in connection with the program, or any breach of the terms of this agreement. I voluntarily accept the legal risk, thereby expressly giving up any right of action and accept the physical risk arising from all liability whether such liability arises in contract, by reason of negligence, or by reason of breach of duty raised by statute, or in any other manner whatsoever.

4. That this agreement shall be governed in all respects by and interpreted in accordance with the laws of Malaysia.

5. I give permission for any photographs/videos of me, participating in the activity, to be used for publicity purposes for RIKL.

6. I confirm that I am over the age of eighteen (18) and have authority to sign this release and that I have read and understood this agreement prior to signing it.

Signed by submitting this form.

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!
To complete your registration
Make payment via online transfer or bank in to

Beneficiary bank: CIMB Bank Berhad (KLCC Branch)
Account name: Pertubuhan Raleigh International Kuala Lumpur
Account number: 800-106-7937

Take a photo/screenshot of the bank in slip/ show us a copy of the receipt and send it to monthlymeet@raleighinternational.org.my for confirmation once your payment is done.

If you have any questions for us, don't hesitate to drop us an email at monthlymeet@raleighinternational.org.my

A copy of your responses will be emailed to the address you provided.
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