Organised by:

JAWATANKUASA KEMAJUAN DAN

KESELAMATAN KAMPUNG (JKKK)
KAMPUNG BUNGA, SERIAN, SARAWAK.
Enquiry:
017-3068596
Registration form:
CATEGORIES:-
Please tick ( √ ) on one relevant category only
( ) Men (Open) 15 KM – RM80.00
( ) Women (Open) 15 KM – RM80.00
( ) Men Veteran (40 years old and above) 6KM – RM70.00
( ) Women Veteran (40 years old and above) 6KM – RM70.00
( ) Boy’s Junior (17 years old and below) 6KM – RM40.00
( ) Girl’s Junior (17 years old and below) 6KM – RM40.00
( ) FUN HIKE 3KM – RM50.00
PARTICIPANT DETAILS:
Participant’s
fullname
IC No/ Passport No
Date of Birth Age
H/phon
Contact No: House
e
Permanent
Address
E-mail
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DECLARATION BY PARTICIPANTS & INDEMNITY
I the undersigned have read and understood the rules of competition and do
hereby agree here to.
All the information particulars supplied by ourselves are true and if found false
we agree that organizers shall have the right to disqualify us from the
competition.
In consideration of being permitted to compete for the events I/ We agreed to the
following:
 I acknowledge that I/ We fully aware of the hazards and dangers invested in
the BUNG SADUNG CLIMBATHON CHALLENGE 2019 and hereby assume
all risk involved in our participation in this event.
 I hereby release, waive, discharge and comments not to sue the promoters,
participants , organizers, ministry, agents, his/ her personal representatives,
assigns, heirs and next of kin FOR ANY AND ALL LOSS OR DAMAGE, ANY
CLAIM OR DEMANDS THEREFORE RELATED TO THE EVENT(S), WHETHER
CAUSED BY NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
 This agreement binds me, heirs, legatee, personal representatives and all
these claiming through me.
 I/ We HEREBY AGREES TO FOLLOW ALL RULES SET FORTH IN THE
BUNG SADUNG CLIMBATHON CHALLENGE 2019 RULES, and agree to
abide by any penalty(s) set by the organizer.

(……………………………………)
Name:______________________________
NRIC No./ Passport No. :________________________________
 Date:______________________________
(For participant aged below 18 years old, must be sign by parents)