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SI Damansara - Cycling for Cycles
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Cycling for Cycles - Registration Form Organised by Soroptimist International Club of Damansara Date : Sunday, 17 July 2016 Time : Registration - 6.30am Flag -off : 7.00am Venue : Dataran DBKL, Jalan Raja Laut
Name
*
Your answer
Gender
*
Male
Female
NIRC / Passport Number:
*
Your answer
Mobile Number:
*
Your answer
Email Address:
*
Your answer
Next of Kin
In case of Emergency
Name
*
Please state name and contact number
Your answer
Contact Number
*
Please state name and contact number
Your answer
Registration Fee is RM 50 per participant
Cash/Cheques payments should be made payable to:
Soroptimist International Club of Damansara
Public Bank Berhad Account No: 3073432710
Please email bank-in slip to
soroptimist.damansara@gmail.com
or whatsapp bank-in slip to Saradha @ 019-3152287.
On-line payment will be via
www.simplygiving.com/NonProfit/SID
Payment method
*
Cash / Cheque payment to Soroptimist International Club of Damansara
Online Payment via
www.simplygiving.com/NonProfit/SID
Other:
T-Shirt Size
*
All registered participants will be entitled to a goody bag & T-shirt
S
M
L
XL
Required
Disclaimer
I hereby declare that I am entering the Cycling for Cycles event at my own risk and shall not hold the organiser, its agencies and sponsors responsible for any incident, injury, death or loss of property caused before, during and after the event. I further certify that all the particulars given above are correct.
*
I agree
I disagree
Required
For further inquiries please contact Saradha ( 019-3152287) or Rose (016-6909787)
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