BORANG PENDAFTARAN

Kejuaraan Cub Prix AAM Malaysia PETRONAS 2010

Pertandingan ini adalah dibawah undang-undang pertandingan Nasional Persatuan Otomobil Malaysia.

Round 1 - Alor Setar Round 2 - Kluang Round 3 - Batu Kawan Round 4 - Litar Sepang (U) Round 5 - Kuala Terengganu
PERYERTAAN KATEGORI PELUMBAAN:
CP 130 CP 115 WIRA

Round 6 - Teluk Intan Round 7 - MIMC Melaka Round 8 - Pekan Round 9 - Litar Sepang (S) Round 10 - Padang Kota Lama

Persendirian

Yuran Decal

BUTIRAN PELUMBA (RIDER) : NAMA: ALAMAT: NO. LESEN (AAM) PELUMBA. TARIKH LAHIR: PENDAFTARAN PASUKAN (TEAM) : NAMA: ALAMAT: TEL: FAX: NO LESEN (AAM) PASUKAN. JENIS DARAH: TEL: FAX. NO. KELAB:

MODEL MOTOSIKAL: KAPASITI: No. PENYERTAAN (Nombor Perlumbaan) : YURAN PENYERTAAN (SETIAP PUSINGAN):
Pendaftaran Awal CP 130 CP 115 WIRA Persendirian RM200.00 RM150.00 RM100.00 RM50.00 Pendaftaran Biasa RM250.00 RM200.00 RM150.00 RM100.00
1. Sila masukkan jumlah yuran penyertaan yang sepatutnya ke Bank Akaun SAFE AIM MUTUAL SDN BHD CIMB Bank 12750000975058. Pastikan borang berkenaan di Fax ke 03-87331122 Borang Penyertaan Borang Indemnity Slip Bayaran Bank (Bank In Slip) Pendaftaran Awal akan ditutup setiap Rabu sebelum tarikh Perlumbaan.

2. A) B) C) 3.

YURAN DECAL:RM 500.00 setiap motor/pusingan

BORANG PENDAFTARAN
Kejuaraan Cub Prix AAM Malaysia PETRONAS Sprinta 2008 Malaysia AAM 2010
Pertandingan ini adalah dibawah undang-undang pertandingan Nasional Persatuan Otomobil Malaysia.

Round 1 - Alor Setar Round 2 - Kluang Round 3 - Batu Kawan Round 4 - Litar Sepang (U) Round 5 - Kuala Terengganu
PERYERTAAN KATEGORI PELUMBAAN:
Honda icon Challenge Cup

Round 6 - Teluk Intan Round 7 - MIMC Melaka Round 8 - Pekan Round 9 - Litar Sepang (S) Round 10 - Padang Kota Lama

Yamaha 135LC Challenge

BUTIRAN PELUMBA (RIDER) : NAMA: ALAMAT: NO. LESEN (AAM) PELUMBA. TARIKH LAHIR: JENIS DARAH: TEL: FAX. NO. KELAB:

MODEL MOTOSIKAL: KAPASITI: No. PENYERTAAN (Nombor Perlumbaan) : YURAN PENYERTAAN (SETIAP PUSINGAN):
Yuran Pendaftaran Honda icon Challenge Cup Yamaha 135LC Challenge RM50.00/pusingan RM50.00/pusingan
1. Sila masukkan jumlah yuran penyertaan yang sepatutnya ke Bank Akaun SAFE AIM MUTUAL SDN BHD CIMB Bank 12750000975058. Pastikan borang berkenaan di Fax ke 03-87331122 Borang Penyertaan Borang Indemnity Slip Bayaran Bank (Bank In Slip) Pendaftaran Awal akan ditutup setiap Rabu sebelum tarikh Perlumbaan.

2. A) B) C) 3.

INDEMNITY FORM
EVENT: (ACARA) VENUE: (TEMPAT)
PETRONAS AAM MALAYSIAN CUB PRIX CHAMPIONSHIP

ROUND: (PUSINGAN)

I have read the regulations issued for the above meeting and agree to be fully bound by them. In consideration of the acceptance of the entry or my being permitted to take part in the event. I agree to save harmless and keep indemnified all the organizing motorsports clubs, including but not limited to Kelab Motor Johor, Perlis Motorsports Club, Kelab Motor DiRaja Perak & Penang Motor Sports Club, Safe Aim Mutual Sdn Bhd., Sepang International Circuit Sdn Bhd. (SIC), Automobile Association of Malaysia(AAM), the property owners, the Malaysian Government, the meet Sponsors and their Official, Servants, Representative, and Agents from and against all actions, claims, costs, expenses, and demands in respect of death, injury, loss or damage to the person or property of myself, as the case may be, howsoever caused, arising out of or in connection with, this entry or my taking part in this meeting and notwithstanding that the same may have been contributed to or occasioned by the negligence of the above said bodies, their officials, servants, representatives or agents.

ENTRANTS DECLARATION(PENYATAAN PEMOHON)

I declare to the best of my belief that the rider possess the standard of competence necessary for this kind to which this entry relates, and that the vehicle entered is suitable and roadworthy for the event, having regard to the course and the speeds which will be reached.

RIDERS DECLARATION(PENYATAAN PELUMBA) RIDERS DECLARATION

I understand that should I at the time of this event be suffering from any disability whether permaI understand that should I at the time of this event be suffering from any disability whether permanent, temporary or otherwise, which is likely to affect prejudicially my normal control of my vehicle, I nent, temporary or otherwise, which is likely to affect prejudicially my normal control of my vehicle, I will not take part unless I have declared such disabilities to the Automobile Association of Malaysia, will not take part unless I have declared such disabilities to the Automobile Association of Malaysia, who have, following such declarations, issued a license which permits me to do so. who have, following such declarations, issued a license which permits me to do so. The promoter reserves the right to use all photographic images and television footages taken from of The promoter reserves the right to use all photographic images and television footages taken from riders participating in the event for the purposes of any promotional and publicity material. This inthe championship of riders participating in the event for the purposes of any promotional material. cludes such images used in promotional material including but not limited to print, internet and televiThis includes such images used in promotional material including but not limited to print, internet and sion promotions. television promotions.

TANDATANGAN PELUMBA: SIGNATURE OF ENTRANT: NAMA PENUH PELUMBA: FULL NAME OF RIDER: NAMA PASUKAN: TANDATANGAN PENGURUS PASUKAN:

TARIKH: DATE: I.C. NO. I.C. NO. NO. LESEN. TARIKH:

IMPORTANT: THIS INDEMNITY MUST BE COUNTERSIGNED BY THE PARENT OR LEGAL GUARDIAN FOR THOSE THAT ARE BELOW 18YEARS OF AGE. (PENTING:UNTUK PELUMBA BAWAH UMUR 18 TAHUN,BORANG INI HARUS DITANDATANGANI JUGA OLEH IBU/BAPA ATAU PENJAGA MEREKA)

FULL NAME: (NAMA PENUH) ADDRESS: (ALAMAT) SIGNATURE: (TANDATANGAN)

RELATIONSHIP: (PERTALIAN) I.C NO: DATE: (TARIKH)