ENTRY FORM KEEP SATURDAY NIGHT ALIVE WITH ORGAN DONATION DRIVE ORGAN DONATION RUN 2014

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1 ENTRY FORM ORGAN DONATION RUN 2014 RACE AGAINST TIME: RUN FOR LIFE 4.0 DEWAN TUNKU CHANCELLOR, UNIVERSITY MALAYA 24 MAY PM KEEP SATURDAY NIGHT ALIVE WITH ORGAN DONATION DRIVE Let s light up Bukit Cinta, UM campus. A great running route. A hidden gem. Goodie bags, finisher medals and Brooks T- shirt Entertainment throughout the route and at start/finish area

2 CODE CATEGORIES AGE GROUP DISTANCE REPORTING TIME STARTING TIME COLOUR A MEN OPEN 18yrs & above (Born 1996 and B C D E OPEN MEN JR. MEN SR. 18yrs & above (Born 1996 and 40yrs 49yrs (Born ) 50yrs & above (Born 1964 and 40yrs & above (Born 1972 and 10km pm 8.00pm Black Hitam 10km pm 8.00pm Red Merah 10km pm 8.00pm Green Hijau 10km pm 8.00pm Blue Biru 10km pm 8.00pm Merah Jambu Pink F FUN RUN All Age Groups 5km pm 8.30pm White/Black Putih/Hitam G MEN JUNIOR 13yrs under 17yrs ( ) H J JUNIOR TRANSPLANT PATIENTS / ORGAN DONORS 13yrs under 17yrs ( ) 5km pm 8.30pm Brown Coklat 5km pm 8.30pm Purple Ungu All Age Groups 5km pm 8.30pm Yellow/Black Kuning/Hitam All Finisher Will Receive Medal and Certificates REGISTRATION CENTRE 1. FTKLAA Office, 2 nd Floor, Wisma OCM, Jalan Hang Jebat, Kuala Lumpur. Tel: sportftaaa@hotmail.com Website:- ENTRY FEE No. CODE FEE 1 A E RM F H RM J FREE ENTRY BY MAIL Entries together with fees attached MO, PO, Cheque (crossed) and payable to Malaysian Society of Transplantation are to be forwarded to Competition Committee :- Chairman Organ Donation Run 2014, C/O FTKLAA Office, Wisma OCM, Jalan Hang Jebat, Kuala Lumpur. PRIZES IN KIND Prizes in kind, and position medals will be awarded to the first ten (10) from each category A E, G H. ELIGIBILITY This is open to all: Malaysians and non Malaysians.

3 CLOSING DATE 17 th May 2014 or 1,500 participants. INCOMPLETE POSTAL ENTRIES 1. In complete entries, not accompanied with fee, will be rejected. 2. No refund made for wrongful and multiple entries. 3. Proof of posting will not be accepted as of proof of entry. However, for the purpose of entry, competitors are advised to bring along their PO/MO as proof slips as proof. 4. T- shirt / Number (bib) collection:- Date : 23/5/2014 and 24/5/2014. Venue : FTKLAA Office, 2 nd Floor, Wisma OCM, Jalan Hang Jebat, Kuala Lumpur. Time : 10-00am 6.00pm

4 CLOSING DATE 17 th May 2014 OR Once reach 1,500 participants ORGAN DONATION RUN 2014 ENTRY FORM FOR OFFICIAL USE RULES The competition shall be held under MAF rules of Donation Organ Run Category participation. I wish to participate in the following event (please tick ( ) in the appropriate box). Age as on 31/12/2014 Umur akan dikira mengikut tahun pertandingan 31/12/2014. CODE CATEGORIES AGE GROUP DISTANCE ENTRY FEE TICK HERE A MEN OPEN 18yrs & above (Born 1996 and 10km RM B OPEN 18yrs & above (Born 1996 and 10km RM C MEN JUNIOR 40yrs 49yrs (Born ) 10km RM D MEN SENIOR 50yrs & above (Born 1964 and 10km RM E 40yrs & above (Born 1972 and 10km RM F FUN RUN All Age Groups 5km RM G MEN JUNIOR 13yrs under 17yrs ( ) 5km RM 35-00* H JUNIOR 13yrs under 17yrs ( ) 5km RM 35-00* J TRANSPLANT 5km FREE * For those who would like to register, without T- shirt option : RM20-00 per entry CATEGORY (KATEGORI) NAME (NAMA) : PHONE (TELEFON) NO : E- MAIL : ADDRESS/ (ALAMAT) : I/C (KP) NO : GENDER (JANTINA) : MALE / FEMALE D. O. B. (TARIKH LAHIR) : AGE (UMUR) : WAIVER CLAUSE This is to certify that I,, I/C/Passport no, have read and understood the rules and regulations pertaining and forever discharge the FTKLAA & all organisers, the partners, sponsors, their appointed staff and officials of all liabilities, claims, actions, damages, costs including injuries that may be suffered by me before, during and after the event. I understand that this indemnity includes any claims based on negligence, action or inaction of any of the above parties. I recognise the difficulties of the event and attest that I am sufficiently physically fit to compete safety in Organ Donation Run 2014 and I have not been advised otherwise by a qualified medical professional. Signature of participant :. AUTHORISATION BY PARENTS / GUARDIAN OF PARTICIPANTS UNDER 18 YEARS OF AGE I, parent/guardian above named authorizes his / her participation in Donation Organ Run 2014 Signature : Date: IC No. : In the event of a catastrophic or natural disaster resulting in postponement of the above event, organisers shall not be held responsible for any claims what so ever (in any form) made by any individuals or parties concerned.

5 ORGAN DONATION RUN 2014 DATE : 25 TH MAY 2014 PLACE : DEWAN CHANCELLOR, UNIVERSITY MALAYA TIME : 7.30PM All entries should have photocopied IC attached (Borang penyertaan tanpa salinan kad pengenalam tidak akan diterima) CODE CATEGORY AGE DISTANCE FEE MARK G* MEN JUNIOR 13yrs 17yrs ( ) 5km RM H* JUNIOR 13yrs 17yrs ( ) 5km RM * For those who would like to register, without T- shirt option : RM20-00 per entry USE SEPARATE FORM FOR DIFFERENT CATEGORY (SILA GUNAKAN BORANG BERLAINAN UNTUK SETIAP KATEGORI) SCHOOL NAME AD FULL ADDRESS Postcode : Phone no : - NO./ BIL 1 NAME / NAMA PESERTA (CAPITAL/HURUF BESAR) MYKAD NO OR DATE OF BIRTH NO MYKAD ATAU TARIKH LAHIR NO (PESERTA) LEAVE EMPTY (TINGGALKAN KOSONG) I certify that all above qualify to enter this Run. They run with their own risks and will comply with all rules and regulations of the competition. Saya sahkan bahawa semua peserta ini layak mengambil bahagian dalam pertandingan ini. Mereka bertanding di atas risiko mereka sendiri serta akan mematuhi segala peraturan dan undang- undang pertandingan.... Accompanying teacher s name Date / Tarikh School stamp / Cop sekolah (Nama guru pengiring)