Booking Form Family Kemensah Krazy 2015

Booking Form Family Kemensah Krazy 2015 - Malaysians Payment via Bank/Cash
Info - Parent 1
Full Name Parent 1*
Gender Parent 1*
Date of Birth Parent 1*

DayMonthYear
IC Number Parent 1*
For Malaysians only - Others type Passport no.
T-Shirt size Parent 1*
Info - Parent 2
Full Name Parent 2*
Gender Parent 2*
Date of Birth Parent 2*

DayMonthYear
IC Number Parent 2*
For Malaysians only - Others type Passport no.
T-Shirt size Parent 2*
Info - Child 1
Full Name Child 1*
Gender Child 1*
Date of Birth Child 1*

DayMonthYear
IC Number Child 1*
For Malaysians only - Others type Passport no.
T-Shirt size Child 1*
Info - Child 2
Full Name Child 2*
Gender Child 2*
Date of Birth Child 2*

DayMonthYear
IC Number Child 2*
For Malaysians only - Others type Passport no.
T-Shirt size Child 2*
General Info
Nationality*
If any of the participants has a different nationality, please let us know.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
E-mail*
All communication will happen via the e-mail that you mention here. So check it properly!
Distance*
Emergency details
Do you or any of your family members have a medical condition of which we, as event organisers, should be informed? (eg. diabetes, allergies, heart issue...)*
Name of your emergency contact*
Relationship*
Phone number of your emergency contact*

Country CodeArea CodePhone Number
Travel insurance company
Travel insurance policy no.
24h call centre phone no.
I and my family members are attending the event at our own risk. I understand that the organisers will try their best to assist and guide, but are in no way responsible, liable or accountable for any damage, loss, personal injuries, death, etc. By clicking the Submit button for this event I acknowledge that I have read, agreed and accepted the Terms, Conditions, Rules and Regulations. Please note that, when collecting your race pack, you will be asked to sign an excerpt of the Terms, Conditions, Rules and Regulations*

Yes
Payment
After submitting this form you will receive an e-mail with the bank details to pay the participation fee.

Kemensah Kiddos Krazy 5 km - RM55.00 (RM200.00 for Family Pack - Father, mother, two children)
Should be Empty:

Booking Form Family Kemensah Krazy 2015 - Malaysians Payment via Bank/Cash

Emergency details

Payment