KELAB ROADRUNNERS IPOH ANNUAL ROAD RACE 2010
Bukit Kinding, Tg Rambutan. – 7.30AM, Sunday, 12 December 2010
PLEASE USE CAPITAL LETTERS.
FULL NAME AS IN I.C./PASSPORT:
SEX:
I.C. No: - - D.O.B.
Passport No: d d m m y y
e-MAIL: CLUB:
KRI Member: Yes/No
ADDRESS:
POSTCODE: CITY/TOWN:
STATE: COUNTRY:
Hand - T-shirt S M L XL XXL XXXL
Phone: Size:
Insert letters + Please tick the size you have chosen.
Participating A, B, C,D, E, * Subjected to availability and on a first come first
Category: F, G or H served basis. No guarantee of exact size.
To The Organizers,
I ________________________________ hereby enclose CASH/BANKER’S CHEQUE/P.O./ M.O. Number
________________ for RM ______ being payment for my entry above and agree to abide by the conditions
and rules of the Run. I certify that the details given are correct and I am physically fit and sufficiently trained
to finish the Run. I will attempt to complete the Run within the time limit.
Cheques & Cash can be deposited into Kelab Roadrunners Ipoh
Current Account Number with AMBANK Berhad: 003-201-100869-9
WAIVER/INDEMNITY:
In consideration of the Organizers accepting this entry, I upon entry and registration to participate in the above KRI
Annual Road Race 2010, hereby for myself, my heirs, executors and administrators, waive and release any all rights or
claim to damages I may have against the Organizers holding this KRI Annual Road Race 2010, their agents,
successors, race sponsors and co-sponsors for a any and all injuries, death and invalidity I may sustain during the
course of the event or arising as a result of it. I hereby indemnify you and keep you indemnified and waived against all
claims or damages that arises in consequence of the above.
* FOR REGISTRANT UNDER AGE 18 (minor).
I (as a parent or guardian) agree to indemnify and hold harmless each indemnity against any claim for any loss and
consent to emergency medical treatment if my child/ward is injured.
Date: ______________ ________________________ __________________________
Participant’s Signature. * Parent/Guardians signature.
For Official Use:
Entry Fees Payment Cash Cheque M.O./P.O. Bank-in
Receipt No: Details
Receipt Date:
Participating Category: Official Signature:
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CATEGORIES AGES TROPHIES CATEGORIES AGES TROPHIES
JUNIOR WOMEN
A UNDER 18 1-3 OPEN F 18 - 39 1 - 15
MEN
OPEN B 18 - 39 1 - 15
MEN WOMEN
VETERAN C 40 - 49 1 - 15 VETERAN G 40 - 49 1 - 15
MEN
SENIOR D 50 - 59 1 - 15
MEN WOMEN
DIAMOND E OVER 60 1 - 10 SENIOR H OVER 50 1-5
Categories will be based on age groups. Age is determined by year of birth.
All prizes winners may be required to produce their ICs or passports for identification and verification purposes.
ENTRY FEES: ALL KRI MEMBERS: RM 35.00 PARTICIPATING PUBLIC: RM 45.00
SENIOR CITIZENS: RM 20.00 LATE ENTRIES: RM 55.00
(Members & Non-members Age over 60)
Entries close one week before date of event: 05 December 2010
Participation Information:
This 12-K road race is run on macadamized road surfaces on undulating terrain of up to more 250 meters
above sea level.
1. Top finishers in each category will receive trophies and medals
2. All participants who finish the race will receive medals.
3. Race numbers and goodie bags collection:
Venue: Jabatan Belia & Sukan Negeri Perak (Opposite the Perak Stadium)
GPS Co-ordinate: N 04. 6091 degrees E 101. 10265 degrees
Date & Time: 11 December between 10 am and 5 pm
4. For online registration, please log on to www.kelabroadrunnersipoh.blogspot.com. Payments either
through e-banking or bank-in to KRI account (payable to Kelab Roadrunners Ipoh, Am Bank
Account No.
003-201-100869-9, please fax or email your bank-in slips with name and contact number.
5. Full race results will be published and displayed on the KRI website a week later.
6. Lucky draws will be conducted before and after the race. All lucky draw winners’ names and bib
numbers will be displayed at the venue.
7. Two water stations will be provided on the course. Adequate signage will be erected along the route.
8. Program:
6.00 am Late Goodie Bags Pickup 9.00 am Light Refreshments served
6.30 am Participants check in 10.00 am Last runner home
7.30 am Race starts 10.00 am Lucky Draws
8.30 am First Runner Home 10.30 am Prizes Presentation
ALL ENTRY FORMS CAN BE SUBMITTED BY HAND AT:-
Venue Address Contact No
SULTAN ABDUL AZIZ Jalan Brash, 016-531 1260 016-422 8868
RECREATION PARK 5.00 pm to 7.00 pm 012-500 6219 016-566 3147
(Polo Ground) 012-510 0049
FOCUS ACE. 58 – 62 Jalan Theatre
Mr. Thomas Ang 30300 Ipoh 016-566 8810
11.00 am – 8.00 pm 05- 249 3050
This page is to be retained by participants