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Kayuhan Sihat 1 Malaysia - Raub 19/2/2012 - penyertaan percuma
Sekolah/Team Name:
Name:

First NameLast Name
E-mail
I/C Number:
Hand Phone No.

Area CodePhone Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender:

MaleFemale
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY. In consideration of organizer of this event, accepting my application to participate in this activity, I agree: To waive any and all claims I may have in future against the organizer and others involve
AUTHORISATION BY PARENTS/GUARDIAN OF PARTICIPANT UNDER 18 YEARS OLD
Agreed:

YES
T-Shirt Size

SMLXLXXL
Should be Empty:

Kayuhan Sihat 1 Malaysia - Raub 19/2/2012 - penyertaan percuma