Running Event Registration Form

Tuesday, April 3, 2012

Port Dickson Beach Night Run 2011 - Negeri Sembilan

Date: 5th May 2012, Saturday
Venue: Pantai Cahaya Negeri, Port Dickson, Negeri Sembilan
Flag-Off Time: 8pm
Distance: 3km & 6km
Category:
A - Men Open Group (18 years old & above) - 6km
B - Women Open Group (18 years old & above) - 6km
C - Men Open Group for Malaysian (18 years old & above) - 6km
D - Women Open Group for Malaysian (18 years old & above) - 6km
E - School Boys (13 - 17 years old) - 3km
F - School Girls (13 - 17 years old) - 3km
Entry Fee:
Category A & B = RM20
Category C & D = RM15
Category E & F = RM10

Registration Info:
Submission of entry form only through email to: pdbeachnightrun@gmail.com
*Each submission should attached together with the prove of Bank-in slip payment.*
Submission also can be made at:
Majlis Perbandaraan Port Dickson
KM 1, Jalan Pantai,
71009 Port Dickson,
Negeri Sembilan Darul Khusus
Tel: 06-647 1122   Fax: 06-647 4984

Payment Info:
Direct bank-in / transfer to:
Payee Bank: CIMB Islamic Bank
Account No: 0505-0000206-10-2
Account Holder: Kelab Karisma Majlis Perbandaran Port Dickson
 
Race Prize:
Cash Prize:
- Top 10 winner's for categories A to D
- Top 3 winner's for categories E & F.
Medal:
- Top 150 finisherr's for categories A & B
- Top 100 finisherr's for categories C & D
- Top 50 finisherr's for categories E & F
Certficate: For all participants who complete the run.

For more inquiries, please refer to:
En. Dale: 061-748 8173
En. Muzamer: 06-647 1122 or 06-647 1335

Closing Date Registration: 27th April 2012
Registration Form 01.....

Registration Form 02.....

Liability Release & Waiver Form.....

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