Registration Form
REGISTRATION TYPE
Personal Details
Name
Full name as shown in NRIC
Your answer
NRIC
Your answer
Gender
Date of birth
MM
/
DD
/
YYYY
Address
Your answer
Phone number
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Email
Your answer
Shirt Size
Captionless Image
FOR GROUP REGISTRATION ONLY
Group Member Name List (with NRIC and T-Shirt size)
Your answer
Number of Group Members
Your answer
Payment Method
For cash payment please contact Ms Helena Guriding at 088-322042 or Ms Juddy Lasius at 088-322116
Waiver & Release of All Claims and Assumption of Risk
I recognize and acknowledge that there are certain risks of physical injury to participants in The KPJ Colour Run For Cancer Awareness event, and I voluntarily and knowingly agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain as a result of said participation. I further agree to waive and relinquish all claims I may have (or which may accrue to me) as a result of participating in these activities against The KPJ Colour Run For Cancer Awareness organizer including its owners, managers, officers and employees, the race officials, agents, volunteers, sponsors, and the owners and operators of the venue (hereinafter collectively referred to as “Administrators”). Participants registering for the race, programs/activities must recognize that there is an inherent risk of injury when choosing to participate in recreational activities/programs. I agree that I am solely responsible for determining if I am physically fit and/or skilled for the race or activities contemplated by this Assumption and Release. It is always advisable, especially if the participant is pregnant or disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity. I, for myself and my heirs, do hereby fully release and forever discharge the Administrators from any and all claims for injuries, including death or incapacity, illnesses, damages, expenses or loss that I may suffer arising out of, connected with, or in any way associated with the race, program or activities including injuries caused or associated with transportation to and from the event. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. When registering online, my online agreement shall substitute for and have the same legal effect as an original form signature. PARTICIPATION WILL BE DENIED, if I have not accepted this waiver before the start of the event
Required
Payment Guidelines
CASH PAYMENT
Kindly make your payment to Ms. Helena Guriding at the Business Office, Level 1, Block A, KPJ Sabah Specialist Hospital or contact her at 088-322042 (Office Hour Only).

ONLINE PAYMENT
For online payment, participants may remit to:
Business Name : KELAB REKREASI SMC HEALTHCARE
Bank Name : ALLIANCE BANK MALAYSIA BERHAD
Bank Account : 100930015031711

Kindly whatsapp your proof of payment to 016-4492692 for our reference and PLEASE INCLUDE YOUR IC NUMBER in the whatsapp message

COLLECTION OF T-SHIRT
Bring along your receipt of payment for T-Shirt collection purpose. Upon payment of registration fee, participants shall collect their T-Shirt from 10th - 20th April 2017. Participants may collect their T-Shirt in Pedoman Hall, Level 1, Block A, KPJ Sabah Specialist Hospital or contact us at 088-322116/ 088-322115 (Ms. Juddy Lasius/ Mr. Nazarius Justin).

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