Driver's Detail
Driver will be the first contact person for each registration (Pemandu akan di hubungi terdahulu)
Driver's Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
+60 for Malaysia +673 For Brunei
Phone Number
Nationality
Age
*
Gender
*
Male
Female
Blood group
*
Group A+
Group A-
Group B+
Group B-
Group AB+
Group AB-
Group O+
Group O-
T-Shirt Size
*
XS
S
M
L
XL
2XL
3XL
4XL
5XL
Co-Driver Details
Co-Driver is mandatory for this event (Co-driver adalah wajib)
Co-Driver's Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
+60 for Malaysia +673 For Brunei
Phone Number
Nationality
Age
*
Gender
*
Male
Female
Blood Group
*
Group A+
Group A-
Group B+
Group B-
Group AB+
Group AB-
Group O+
Group O-
T-Shirt Size
*
XS
S
M
L
XL
2XL
3XL
4XL
5XL
Additional Passanger? (Penumpang tambahan?)
*
Yes
No
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Passanger
Minimum age requirement for this event is 18 years. However, participants under 18 must be accompanied by their parents (umur min adalah 18 tahun, peserta bawah 18 tahun mesti ditemani oleh ibubapa)
Passanger #1
*
First Name
Last Name
Phone Number
-
+60 for Malaysia +673 For Brunei
Phone Number
Nationality
Age
*
Gender
*
Male
Female
Blood Group
*
Group A+
Group A-
Group B+
Group B-
Group AB+
Group AB-
Group O+
Group O-
T-Shirt Size
*
XS
S
M
L
XL
2XL
3XL
4XL
5XL
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Additional passanger? (penumpang tambahan?)
*
Yes
No
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Passanger
Minimum age requirement for this event is 18 years. However, participants under 18 must be accompanied by their parents(umur min adalah 18 tahun, peserta bawah 18 tahun mesti ditemani oleh ibubapa)
Passanger #2
*
First Name
Last Name
Phone Number
-
+60 for Malaysia +673 For Brunei
Phone Number
Nationality
Age
*
Gender
*
Male
Female
Blood Group
*
Group A+
Group A-
Group B+
Group B-
Group AB+
Group AB-
Group O+
Group O-
T-Shirt Size
*
XS
S
M
L
XL
2XL
3XL
4XL
5XL
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Emergency contact person
Please provide correct details of contact person to be contacted in event of emergency (sila sediakan maklumat untuk orang yang akan dihubungi sekiranya terjadi kecemasan)
Name
*
First Name
Last Name
Relationship to driver (hubungan dengan pemandu)
*
Please Select
Spouse
Sibling
Parents
Relatives
Next of kin
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
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Expedition Category
Hardcore Track Expedition (Up to 10KM)Designed for experienced diverse extreme terrain: mud, steep climbs, river crossings. Overland Adventure CSR Activity & Trip to Lepau Uten camping and cultural interaction,Training 4x4 ClinicBasic to 4x4 Mini Fun Challenge.Ekspedisi Trek Hardcore (Sehingga 10KM)direka untuk peserta berpengalaman dengan pelbagai bentuk muka bumi ekstrem: lumpur, pendakian curam, dan lintasan sungai. Pengembaraan(Overland)Aktiviti CSR & perjalanan ke Lepau Uten, termasuk perkhemahan dan interaksi budaya, latihan asas 4x4,merangkumi teknik pemanduan off-road dan cabaran 4x4 Mini Fun iaitu halangan ringan, sesuai untuk semua peringkat peserta.
Expedition Category
*
Hardcore Expedition
Overland Expedition
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Hardcore Expedition
Vehicle details & requirements
Vehicle Registration Number
*
Vehicle Model / Brand
Vehicle body colour
Engine Fuel Type
Diesel
Petrol
Tyre Size (Mandatory extreme tyre only)
*
Please Select
33
35
36
37
38
40
42
Recovery point/equipments
*
My Vehicle equipped with recovery point/equipment (2 unit of Webbing Slings + Shackles) Kenderaan telah dilengkapi dengan cangkuk penarik serta peralatan tunda ( 2 unit Sling Dan shackles)
I acknowledge the requirements (saya sedia maklum)
Radio Communication equipped?
*
Radio Communication Rigged in Vehicle with 1 unit of hand held (Alat Komunikasi Radio Plantar Tetap Berserta 1 unit Radio mudah Alih)
I acknowledge the requirement(saya sedia maklum)
Valid Vehicle RoadTax & Insurance
*
I am aware of the needs to have my Roadtax & Insurance Valid during the event. (Saya akan pastikan Cukai Jalan Kenderaan Dan Insurance masih sah laku ketika acara NSE)
I acknowledge the requirements (saya sedia maklum)
Fire Extinguisher
*
Im aware the needs of a Fire Extinguisher in my vehicle(Saya sedia Maklum keperluan mempunyai alat pemadam api di dalam kenderaan)
I acknowledge the requirement(saya sedia maklum)
Enough Food Ration/Drinking Water For 4 days & 3 Nights
*
I Acknowledge the requirements (Saya sedia maklum)
Camping gears
*
I Acknowledge the requirements (Saya sedia maklum)
Basic First Aid Kit
*
I Acknowledge the requirements (Saya sedia maklum)
Rubbish/Waste Management
*
I Acknowledge the requirements to manage my own Rubbish / waste (Saya Sedia Maklum untuk mengurus sampah sendiri)
No Fishing & Hunting
*
I Acknowledge the requirements (Saya Sedia Maklum)
All registered participants is Fit & Healthy
*
All participants registered in this form is healthy & fit for offroading activities (semua peserta berdaftar didalam borang ini sihat tubuh badan untuk menyertai acara offroad)
I acknowledge the requirements (saya sedia maklum)
Anti-Malarials protection
*
I will ensure me & my passenger takes this mandatory precaution (Saya Sedia Maklum)
Participants shall adhere to all set terms and organizer instructions. The organizer reserves the right to impose sanctions for any breach of regulations. In the event of an accident, the organizer is indemnified against all claims, and participants agree to waive any right to legal recourse.Peserta hendaklah mematuhi semua terma yang telah ditetapkan serta arahan pihak penganjur. Pihak penganjur berhak mengenakan tindakan atas sebarang pelanggaran peraturan. Sekiranya berlaku sebarang kemalangan, pihak penganjur dilepaskan daripada semua tuntutan, dan peserta bersetuju untuk mengetepikan sebarang hak bagi tindakan undang-undang
*
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Overland Expedition
Vehicle details & requirements
Vehicle Registration Number
*
Vehicle Model / Brand
Vehicle body colour
Engine Fuel Type
Diesel
Petrol
Tyre Size (Minimum MT tyres)
*
Please Select
31
33
35
36
37
38
40
42
Recovery point/equipments
*
My Vehicle equipped with recovery point/equipment (2 unit of Webbing Slings + Shackles) Kenderaan telah dilengkapi dengan cangkuk penarik serta peralatan tunda ( 2 unit Sling Dan shackles)
I acknowledge the requirements (saya sedia maklum)
Radio Communication equipped?
*
Radio Communication Rigged in Vehicle with 1 unit of hand held (Alat Komunikasi Radio Plantar Tetap Berserta 1 unit Radio mudah Alih)
I acknowledge the requirement(saya sedia maklum)
Valid Vehicle RoadTax & Insurance
*
I am aware of the needs to have my Roadtax & Insurance Valid during the event. (Saya akan pastikan Cukai Jalan Kenderaan Dan Insurance masih sah laku ketika acara NSE)
I acknowledge the requirements (saya sedia maklum)
Fire Extinguisher
*
Im aware the needs of a Fire Extinguisher in my vehicle(Saya sedia Maklum keperluan mempunyai alat pemadam api di dalam kenderaan)
I acknowledge the requirement(saya sedia maklum)
Enough Food Ration/Drinking Water For 4 days & 3 Nights
*
I Acknowledge the requirements (Saya sedia maklum)
Camping gears
*
I Acknowledge the requirements (Saya sedia maklum)
Basic First Aid Kit
*
I Acknowledge the requirements (Saya sedia maklum)
Rubbish/Waste Management
*
I Acknowledge the requirements to manage my own Rubbish / waste (Saya Sedia Maklum untuk mengurus sampah sendiri)
No Fishing & Hunting
*
I Acknowledge the requirements (Saya Sedia Maklum)
All registered participants is Fit & Healthy
*
All participants registered in this form is healthy & fit for offroading activities (semua peserta berdaftar didalam borang ini sihat tubuh badan untuk menyertai acara offroad)
I acknowledge the requirements (saya sedia maklum)
Anti-Malarials protection
*
I will ensure me & my passenger takes this mandatory precaution (Saya Sedia Maklum)
Participants shall adhere to all set terms and organizer instructions. The organizer reserves the right to impose sanctions for any breach of regulations. In the event of an accident, the organizer is indemnified against all claims, and participants agree to waive any right to legal recourse.Peserta hendaklah mematuhi semua terma yang telah ditetapkan serta arahan pihak penganjur. Pihak penganjur berhak mengenakan tindakan atas sebarang pelanggaran peraturan. Sekiranya berlaku sebarang kemalangan, pihak penganjur dilepaskan daripada semua tuntutan, dan peserta bersetuju untuk mengetepikan sebarang hak bagi tindakan undang-undang.
*
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Participation Fee
MYR350/ Pax
Please select fee category
*
MYR 700 (2 pax) *Driver + Co-Driver
MYR 1050 (3 pax) *Driver + Co-Driver + 1 Passanger
MYR 1400 (4 pax) *Driver + Co-Driver + 2 Passangers
OFFICIAL TEAMS
PLEASE TRANSFER/ MAKE PAYMENT TO ACCOUNT NAME: KELAB SUKAN BERMOTOR KEMBARA PACUAN EMPAT RODA TAMAN TUNKU BANDAR MINYAK, ACCOUNT NUMBER CIMB 8007899520. (Sila buat pembayaran ke account kelab kami) ACCOUNT NUMBER CIMB 8007899520
*
Browse Files
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Please Upload the transaction slip (put vehicle number as reference) *** Sila upload resit (letakkan number plat kenderaan sebagai rujukan)
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Event registration contact personnel
PLEASE DO CONTACT THE PERSONAL BELOW FOR ANY ENQUIRY REGARDING THIS ONLINE REGISTRATION.
Donny aka Tigal : +60128450332
Moses : +6
0168165848
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