Ride For Nokor Tep 2018 Event Registration
Event Address and Timing:

Thailand: Saturday 27th October 2018 - Wednesday 31st October 2018
Cambodia: Wednesday 31st October - Monday 5th November 2018
Vietnam: Monday 5th November 2018 - Tuesday 6th November 2018

- Cyclists Registration Form
- Acknowledgement and Declaration; Obligations, Release, Waiver and Indemnity Agreement

I hereby apply to the organiser to participate in the Event.

I understand that the cost of the event will be approximately:

9-day option (whole route 28/10 – 05/11): USD 2250
7-day option (Bangkok to Phnom Penh 28/10 – 2/11): USD 1700
3-day option (Phenom Penh to Saigon 02/11- 05/11): USD 830

not including airfares and will be subject to the number of participants joining.

I also understand that this is a charity event and I am expected to help raise funds through donations to help the completion of Nokor Tep Hospital Cambodia.

Individuals are required to raise a minimum of USD 1000 to participate and Couples are required to raise a minimum of USD 1500. Support Crew do not have a minimum required in respect of funds raised.
Email address *
Section 1: Personal Particulars
If you are below 18 years of age (as of 27th October 2018), Parents/Legal Guardian details must be provided at Section 6 of this form. Your Parent or Legal Guardian must agree and accept all terms and conditions hereunder, including the said Agreement.
Salutation *
First Name *
Your answer
Nickname *
Your answer
Surname *
Your answer
Employer *
Your answer
What Itinerary will you be following? *
I will be attending the event as *
I will be bringing my own road bike *
Required
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Mobile number including country code *
Your answer
Passport Number *
Your answer
Full Name as in Passport *
Your answer
Passport Expiry Date *
MM
/
DD
/
YYYY
Nationality *
Your answer
Country of Current Residence *
Your answer
In Case of Emergency
Contact Person *
Your answer
Relationship to you *
Your answer
Contact Number *
mobile preferred including country code
Your answer
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