Randonneur Awards
Register before 31st Oct 2018. Certificate will be given out during SR ceremony in November 2018.
Award type *
Please select the following completed BRMs: *
BRM200 Nov 17
BRM400 Dec 17
BRM200 Jan 18
BRM200 Feb 18
BRM300 Mac 18
BRM200 April 18
BRM300 May 18
BRM600 June 18
BRM400 July 18
BRM600 Aug 18
BRM1000 Sept 18
2018 BRMs
Please key in BRM homologation numbers (homologation number can be found in https://audaxmalaysia.com/portfolio/homologation-numbers/) :
BRM200:
BRM300:
BRM400:
BRM600:
BRM1000:
Display box dimension:  7"(L) x 3"(W) x 2"(H) - to display 5 medals including SR medal

Material: High quality Acrylic

Name to be appeared on Certificate *
Email *
Contact no. *
SR 2018 Registration
RM65.00 for Randonneur 1000 Registration (certificate and display box)
RM85.00 for Randonneur 2500, 3500, 4500 (certificate and display box)
_____________


Please make payment to the following bank:
Hong Leong Bank
Account no.: 338-00-03111-1
Account Name: Jam Jar & Jazz Design Studio

By confirmation of payment, the participant agrees to abide by the rules and regulations of Audax Club Parisien. All registration are NOT transferable nor refundable.

PROOF OF PAYMENT *
Please upload the bank in slip as proof of payment before submitting the form.
Required
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