ENTRY FEE RM 85.00

 

MALAYSIA DOWNHILL SUPER SERIES #3  

Darulaman Bike Park Jitra , Kedah 29 Mei 2011

 

Select  your category Below 

Contact 012-4583 221

Bil

Lontruth

019-4440 839

Zam Hamid

013-4260 345

1 2 3 4 5 6 7 8

Wan Blitz

DAY X STREET EVENT MANAGEMENT  N0. B – 467,  Taman Wira Mergong, 05300 Alor Setar, Kedah Darul Aman  E‐Mail: [email protected] Fax: 604‐730 2839 

Category

Age

√

Elite Expert Open/Sport Master A Master B Junior Women Hard Tail

     

Entry Fee:   Local/International RM85.00

     

• Entry fee must be paid upon submission of entry form • Entry Fee for each category

 

  Participants Detail

  Persatuan Berbasikal Negeri Kedah Darul Aman

  Disclaimer (must read and sign) Kedah Downhill , the organizer of Darulaman Challenge 2011 accept no responsibility for any accident, injury, death, loss of property arising before, during and after the event.

Name

:

I/C No.Passport

:

Date Of Birth

:

HP No.

:

Citizenship:

:

E-Mail address

:

Mailing Address

:

Male/Female Age:

Club:

:

I Hereby agree to assume all risks associated my participations in Darulaman Challenge 2011. Emergency Contact ……………………………………………. Participant’s Signature

Name

:

Contact no.

:

Medical Informatian: Please inform us if you have any medical conditions/allergies

Parent or Guardians Consent (below 18 years) Name IC/No. Passport Contact No. Relationship

……………………………………………. Signature

Payment Method:

Cash

Cheque

Online transfer

   

All payment should be made to :   DAY X STREET EVENT MANAGEMENT Muamalat Bank: Account No. 020 60000 1677 31 3

Please complete the details and fax with the payment slip. Photocopy enlarge your bank slip on A4 paper and please write on your full name, telephone number and categories(clearly) on top or bottom