Date: 1st April 2018,Time: 6:00am

Venue: Kampung Bakam, Miri

Flag Off: 6:00am (36km); 6:15am (15km),
Closing Date: 3th March 2018 Limit to 500 participants only

KAMPUNG BAKAM TRAIL RUN 2.0 Powered by

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Registration Form
CATEGORY *Do tick √ inside box
A.36 KM Men Open B.36 KM Women Open C. 15 KM Men Open D.15 KM Women Open
*Registration Fee 36KM – RM180/pax, 15KM- RM100/pax * For 15km category, the runners must have completed a few races of
st
* Age meet minimum age on 1 April 2018 a minimum distance of 5km road race a few times in order to be

*For 36km category, runners must have completed a few races of a qualified for registration

minimum distance of 10km road race a few times in order to be *Registration is Open to 15 KM age 16 years and above only.

qualified for registration *Registration is Open to 36 KM age 18 years and above only.

Participant's Details:
Hj Japar Hj Tuah 00-122032
Name: ______________________________________ NRIC / Passport No: ___________________________
Brunei Darussalam 47 28.04.1970
Nationality: _________________________________ Age: ____________D.O.B: _____________________
japar_mfs@yahoo.com
Gender: M/ F Email address: ________________________ 673 8164900
Contact Number: ____________________
Hjh Suriana / 673 8174900
Emergency Contact (Name / Phone Number):________________________________________
Previous Event History details: *Refer above instruction
No. Event Name Bib number/Name Distance Result/Timing Year
1 Borneo Ultra Trail Marathon 120 / Hj Japar Hj Tuah 100 km Finished / 30:56:36 2017

2
Shirt Size Details: Do tick inside box
√

XXS L
XS XL
S XXL
M

Declaration

By participating in the event, I have read and understood the rules & regulations and I agree to participate on the understanding that, I must adhere to ALL the rules

and regulations stipulated.

WAIVER CLAUSE : In consideration of the acceptance of my entry, I, my heirs, successors and assigns, do hereby unconditionally and irrevocably waive and release the

organizers, the event sponsors and partners as well as all persons, servants, contractors, agents, service providers, volunteers and agencies connected with it from all

complains, demands, claims, liabilities, proceedings, suits, losses and/or damages of any kind whatsoever due to or relating to or arising directly or indirectly out of my

participation in the event, including without limitation, personal injury and/or death.

Japar Tuah
______________________ _____________________________

Participant’s signature Guardian’s Signature for applicant age below 18 Date: 16

________________
January 2018

Any enquiry please contact Mr Pui H/P: 016-883 5211 or Ms Bec H/P: 012-866 9874