ENGINEER'S RUN 2015INDIVIDUAL FORM

SUNDAY, 13 SEPTEMBER 2015, 6.15 A.M

DISTANCE CATEGORY 13KM 6KM

DETAILS

NAME

ADDRESS

I/C / PASSPORT NO IEM MEMBERSHIP NO

GENDER MALE FEMALE NATIONALITY

DATE OF BIRTH (DD/MM/YY) AGE (AS OF 31 DEC 2015)

E-MAIL CONTACT NUMBER

TEE SIZE* XXS XS S M L XL XXL

EMERGENCY CONTACT NAME

EMERGENCY CONTACT NUMBER RELATIONSHIP

CATEGORY

MEN'S OPEN (10YR OLD-44YR OLD) WOMEN'S OPEN (10YR OLD-44YR OLD)

MEN'S VETERAN (45YR OLD & ABOVE) WOMEN'S VETERAN (45YR OLD & ABOVE)

WAIVER

PARENTS / GUARDIAN SIGNATURE(MINOR) PARTICIPANT'S SIGNATURE

OFFICE USE:EARLY BIRD NORMAL FEE

ORDER NO:

6KM RM 50 RM 70RECEIPT NO:

13KM RM 65 RM 80

In consideration of my participation in the ENGINEER'S RUN 2015, I agree to assume all risks incidental to such participation (which risks may include, among other things, muscle injuries, heat and stress related issues and broken bones). On my own behalf, and on behalf of my heirs, executors, administrators and next of kin, I hereby release, covenant not to sue, and forever discharge the Released Parties (as defined below) of and from all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with my participation in the ENGINEER'S RUN 2015 and further agree to indemnify and hold each of the Released Parties harmless from and against any and all such liabilities, claims, actions, damages, costs or expenses including, but not limited to, all legal fees and disbursements up through and including any appeal (Claims). I understand that this release and indemnity includes any Claims based on the negligence, action or inaction of any of the Released Parties and covers bodily injury (including death), property damage, and loss by theft or otherwise, whether suffered by me before, during or after such participation. I declare that I am physically fit and have the skill level required to participate in the ENGINEER'S RUN 2015. I further authorize medical treatment for me, at my cost, if the need arises. For the purposes hereof, the "Released Parties" are THE INSTITUTION OF ENGINEERS, MALAYSIA(Sabah Branch) and all ENGINEER'S RUN 2015 sponsors or charities, and each of their respective parent, subsidiary, affiliated or related companiesI further grant the Released Parties the right to photograph and/or videotape me and further to display, use and/or otherwise exploit my name, face, likeness, voice, and appearance forever and throughout the world, in all media, whether now known or hereafter devised, throughout the universe in perpetuity (including, without limitation, in online webcasts, television, motion pictures, films, newspapers, and magazines) and in all forms including, without limitation, digitized images, whether for advertising, publicity, or promotional purposes, including, without limitation, publication of ENGINEER'S RUN 2015 results and standings, without compensation, reservation or limitation, or further approval, and I agree to indemnify and hold harmless the Released Parties for any Claims associated with such grant and right to use. The Released Parties are, however, under no obligation to exercise any rights granted herein.

This Waiver and Release Form shall be governed by the laws of Malaysia. I certify I am 18 years of age or older and the information set forth is true and complete.

In consideration of your minor child being permitted to participate in the ENGINEER'S RUN 2015 you hereby attest that, after reading this Waiver and Release Form completely and carefully, you acknowledge that participation in the ENGINEER'S RUN 2015 by your child is entirely voluntary, and that you understand and agree as the following above

Early Bird: RM 65.00*(Until 01/06/15)

Normal Fee: RM 80.00*

Organised By

IEM SABAH

(Tick ) (Tick )

Early Bird: RM 50.00* (Until 01/06/15 )

Normal Fee: RM 70.00*

*MEASURMENT TO BE PUBLISHED

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(Circle O)

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* Registration Fee is inclusive of 6% GST. (IEM Sabah - GST ID NO: 001317462016)Forms & Payment Submission:a) IEM SABAH @ Damai - 088-259122 (Ms Wendy) b) Performance Sportz @ Likas Driving Range - 088212268 (Mr. Rudy/Ms. Marjie)