Borang Penyertaan / Entry Form

Larian Gemilang Merdeka 50 Tahun

Borang Penyertaan / Entry Form

Cara 1 / Method 1:

Bank in RM10.00 per entry .

      Beneficiary's Bank : CIMB bank ,Batu Pahat Branch.
      Beneficiary's Bank No. : 0105-00-14201-05-9
      Beneficiary's Account Name : Tabung Larian Gemilang Merdeka

Collect the bank-in slip and key-in this entry form

1. Nama/Name
2. No. Kad Pengenalan / No. Passport :
3. Tarikh Lahir / Date of Birth
4. Jantina / Gender
5. Alamat surat menyurat yang lengkap : Kampung / Jalan / Taman
6. Negeri/State
7. No. Tel. / Phone No.
8. Warganegara / Citizenship
Jika Malaysia
9. Saiz Kemeja ‘T’ / T-Shirt Size
10. KATEGORI / CATEGORY
11. Tarikh / Date
Cod Bank/Bank Code
Amaun/Amount
Tarikh Bank-In Date
Emel/Email

Cara 2 / Method 2

Bank in RM10.00 per entry .

      Beneficiary's Bank : CIMB bank ,Batu Pahat Branch.
      Beneficiary's Bank No. : 0105-00-14201-05-9
      Beneficiary's Account Name : Tabung Larian Gemilang Merdeka

Collect the bank-in slip and fill-up the download Entry form

and fax to 074334117 along with the bank-in slip

Download

Borang Penyertaan / Entry Form

Isikan Borang Penyertaan

Entry Form

dan Fax ke Urusetia LGM50.

07- 4334117

Stok T-Shrit Terhad / T-Shirt stock Limited

Kump./Group

Kategori/Category

Kump.Umur/Age group

Jarak/Distance

A

Lelaki Terbuka/Men Open

18 hingga 40

18 years - 40 years

10 km

B

Perempuan Terbuka/Women Open

18 dan ke atas

18 years and above

7 km

C

Lelaki Veteran/Men Veteren

41 dan ke atas

41 years and above

7 km

D

Junior Lelaki/Junior Boys

13 -17 tahun/years

7 km

E

Junior Perempuan/Junior Girls

13 -17 tahun/years

7 km

F

Pelajar STBP sahaja/High School Boys

13 -17 tahun/years

7 km

Bayaran/Fees

RM 10

Keterangan lanjut sila hubungi

TN. HJ Shukor 019-7269654

EN. Subra 012-7623628