Page 0: Page 1: Penang Downhill Challenge 2010 organised by Earth Gravitee co-organised by Penang Cycling Association Date Time Venue Entrance Fee : Sunday, 26 September 2010 : 0730 – 1700 : Downhill Trail @ Mount Erskine, Penang, Malaysia : RM85.00 (Closing Date: Thurs, 26 Aug 2010 | Late Entry Fee: RM100) Plate No: RIDER'S PARTICULARS Name : ______________________________________ D.O.B. : ______________________ Age: ______________ Gender : 5 Male 5 Female I/C / Passport No : _________________________________________ Tel : ______________________________________ Email : _________________________________________ Address : _______________________________________________________________________________________ State/Team : __________________________________ Nationality : _________________________________________ Emergency Contact No: _________________________ Contact Name : _________________________________________ Category - please P tick below where appropriate 5 5 5 5 Elite – State/National Riders/Sponsored Riders Expert – Sponsored Riders/Junior State Riders Junior – Age 18 and below Sports – Hobbyist age 19 to 29 5 Master – Hobbyist age 30 and above 5 Women* 5 Hardtail* * for participants of less than 15, participants will be included in other category Kindly submit completed entry form & entry fee of RM85 at any of the folllowing authorised representatives: PENANG Payment Method : 5 CCI 5 KSH Bicycle 5 KT Cycletron KL: 5 KSH Bicycle TTDI : 5 Cash 5 Cheque No: ____________________________ 5 Direct Bank in to Earth Gravitee Ent at Hong Leong Bank Account No.: 14100008726 Reminder: Kindly scan and email your bank-in slipss to king_of_erskine@yahoo.com LEGAL NOTICE AND DISCLAIMER The Organiser of 'King of Erskine Penang Downhill Challenge 2010' (hereinafter referred to as the “Event”) that will be held on 26 September 2010, namely Earth Gravitee has taken all due care and caution in the preparation to organise the Event with reference of MNCF and UCI legal and safety guidelines. Due to the nature of the downhill sport, the Organiser accepts no responsibility of any kind whether directly or indirectly for any/all losses, damages, costs or expenses (including consequential losses and damages or death) arising from or incurred by any cause whatsoever (including negligence of any person) to any person, participant, equipment, vehicle (inclusive of any fittings or accessories) or valuables suffered directly or indirectly by any participants, volunteers, officials, and/or third party observers and/or passersby during the Event. Participation in the Event is at the participant's own risk. The Participant hereby represents and warrants that the Participant is of 18 years or above. Where the Participant is below the age of 18, a written parental consent is strictly required. Thus, parents of Participants below the age of 18 is required to endorsed the 'Parental Consent' section stated below: PARENTAL CONSENT DECLARATION I, _______________________________________ ,Father/Mother/Legal Guardian, hereby acknowledge that I have read and fully understood the terms and conditions of participations in the Event and give my consent to ______________________________'s to participate in the Event. We shall waive any right of claims against the Organiser, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation, organisation and/or management of the Event. Acknowledge By Participant's Parent/Guardian Signature : Name : I/C / Passport No.: Date : Where applicable as a matter of caution, all Participants ought to sought to ensure that his or her insurance policy or policies is not void or voidable as a result of the Participant's participation in the Event. All Participants have ensured that their sporting equipment and safety geaer have been recently examined by a skilled mountain bike mechanic, serviced and certified to be fit for use in the Event. PARTICIPANT'S DECLARATION I, ________________________________________ hereby declare that I have read and fully understood the terms and conditions of participations in the Event and will participate in the Event at my own accord. Hereby, confirms by unconditional acceptance of the terms of participations and shall waive any right of claims against the Organiser, their members, employees, agents or such other parties involved whether directly or indirectly in the preparation, organisation and/or management of the Event. Acknowledge By Participant Signature : Name : I/C / Passport No.: Date : Contact Personnel En. Murni (PCA) +6012 4098 110 | CK Ooi +6012 455 5506 | Paul Cheah +6012 470 1333 | Tom Jee +6012 477 9595 For overseas riders, kindly mail completed entry forms to king_of_erskine@yahoo.com Page 2: