ENHANCE YOUR POTENTIAL

Running Registration Form
5K RUN of Prasmul Olympics 2019

NAMA KOMUNITAS* :

RUNNER 1

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 2

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 3

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 4

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 5

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 6

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 7

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 8

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 9

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 10

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 11

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 12

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 13

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 14

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 15

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 16

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 17

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 18

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 19

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

RUNNER 20

 
Full Name* :  
ID Number*:
Date of Birth* (ddmmyyyy) :
Sex* :
Address* :
Phone Number* :
E-mail* :
Cloth Size* :    size chart
Diseases/ Injuries :
How do you know Prasmul Olympics* :

*ID Card used during registration must be brought when redeeming the racepack.

**Runners must be at least 13 years old for 5K and 15 years old for 10K when the event occurrs.

***Release waiver (permission letter from parents) must be brought by runners under 17 years old when event occurs.

****Runner's private email is used for sending confirmation letter needed to redeem the racepack.

Runners who registered on the event state themselves as healthy both physically and mentally. Any injuries and damages that occur before, during, and after the event is not the responsibility of committees.

I here by agree with the terms and conditions and state the informations above correctly