SECTION 1: EVENT DETAILS
Category
Kategori
Choose..
Non-Malaysians Men's/Women's Open 10km RM100.00
Malaysian Men's/Women's Open 10km RM70.00
Fun Run 5km RM50.00
Name on Bib
T-Shirt Size
Choose..
XXL
XL
L
M
S
XS
SECTION 2: PARTICIPANT'S DETAILS
Name
National Registration Identity Card (NIRC)/Passport Number
Gender
Choose..
Male
Female
Date of Birth YYYY/MM/DD
Nationality
Choose..
Malaysian
Other
Address
Postcode
City
State
Choose..
Kuala Lumpur
Labuan
Putrajaya
Johor Darul Takzim
Kedah Darul Aman
Kelantan Darul Naim
Melaka Bandaraya Bersejarah
Negeri Sembilan Darul Khusus
Others
Pahang Darul Makmur
Perak Darul Ridzuan
Perlis Indera Kayangan
Pulau Pinang Pulau Mutiara
Sabah Negeri Di Bawah Bayu
Sarawak Bumi Kenyalang
Selangor Darul Ehsan
Terengganu Darul Iman
Country
Choose..
Malaysia
Other
Phone
Email
Do you have any medical conditions, allergies or disabilities?
Blood Group
Choose..
A
AB
B
O
SECTION 3: CONTACT PERSON IN CASE OF EMERGENCY
Contact Name
Contact Number
Relationship
Choose..
Father
Mother
Wife
Husband
Others
Siblings
Son-Daughter
Grandchildren
Aunt
Grandfather
Grandmother
Uncle
SECTION 4: FORM SUBMISSION
Hereby, I agree to share my contact details to UMBI's Cancer Run sponsor:
Yes
No
By submitting my entry form for UMBI's Cancer Run and paying the registration fees, I hereby agree:
To abide by the rules and regulations set by UMBI's Cancer Run Organizer as stated in the
Race Info
.
To waive all rights to any claim of personal injuries, accidents, and all other losses or damages that may be sustained before, during and after the event.
To forfeit my race kit if I fail to collect it within the stipulated time frame.
For the organizer to use any photographs/video taken before, during and after the event for promotional/educational use.
I certify that all the details given are correct.
Description