Official entry form



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Competition No



OFFICIAL ENTRY FORM

Yes, we would like to participate in the 8th Hospis Malaysia Charity Treasure Hunt 2009
Team name: __________________________

Vehicle registration No: __________________ Road Tax expiry date: _______________________

Vehicle make / model : _______________________
Particulars of Driver:

Mr / Ms / Mdm : _________________________________ Driving license : _____________ Expiry date : ________

Address: ______________________________________ Email : _______________________________________

___________ __________________________________

Tel No / Mobile: ___________________ (O) __________ (H) __________________________________________

T-shirt: S / M / L / XL


Particulars of Navigator

Mr / Ms / Mdm: ________________________________ Driving license : _____________ Expiry date : ________

Address: _____________________________________ Email : _______________________________________

_____________________________________________

Tel No / Mobile: ___________________ (O) _________ (H) __________________________________________

T-shirt: S / M / L / XL


Particulars of Passenger 1:

Mr / Ms / Mdm : ________________________________ Email : _______________________________

Address: _____________________________________

_____________________________________________

Tel No / Mobile: ___________________ (O) _________ (H) __________________________________

T-shirt: S / M / L / XL


Particulars of Passenger 2:

Mr / Ms / Mdm: ________________________________ Email: ________________________________

Address: _____________________________________

_____________________________________________

Tel No / Mobile: ___________________ (O) _________ (H) __________________________________

T-shirt: S / M / L / XL


ENTRY FEES (* SEE Rules & Regulations)
RM 180 @ per participation ( STAYING OVER ) * INCLUDES PRIZE GIVING CEREMONY DINNER

RM 100 @ per participation ( NOT STAYING OVER ) * INCLUDES PRIZE GIVING CEREMONY DINNER


Attached cash / ___________________________ Cheque No: _________________ ____________in favour of Hospis Malaysia being payment
INDEMNITY

We declare that the particulars stated herein are true ad complete. We have read the rules and regulations governing this event and hereby agree to abide by them. We further indemnify the organizers and those connected with the organizers against any injury, accident or death to ourselves or damage or loss incurred to the vehicle hereby entered, however caused, arising out of our taking part in this event. We further declare that the vehicle entered is covered by insurance and road tax duly paid as required by the motor vehicles rules (third party risks) 1959 (Malaya which is valid for an event such as this

Driver : ______________________ NRIC No : ____________________ Signature : __________

Navigator : ___________________ NRIC No : ____________________ Signature : __________

Passenger 1 : _________________ NRIC No : ____________________Signature : __________

Passenger 2 : __________________NRIC No : ____________________ Signature : __________


For official use only : Received By : ______________________________ Date : ______________­­­

Receipt No : __________________



Remarks : ______________________________________________________________________
Hospis Malaysia 8th Charity Treasure Hunt 2009
Terms & Conditions :


  1. The Hospis Malaysia 8th Charity Treasure Hunt 2009 is a Motoring Treasure Hunt lasting for about 8 hours. At some point it is necessary to get down and obtain answers at the heritage site.

  2. Entry forms must be fully completed and the indemnity declaration duly signed by all participants in the team. Only official entry forms will be accepted. Fees were to be fully paid by 5th June 2009 before it can be officially accepted and processed.

  3. A team shall comprise a maximum 4 participants and minimum 2.

  4. The driver and navigator must possess a valid driving license and the vehicle must be covered by a valid road tax and insurance.

  5. A briefing will be held on 19th June, 2009 at 6pm in Hospis Malaysia Daycare Centre.

  6. The organizer reserves the rights to amend the rules, change or postpone the date, or cancel the event if it is deemed necessary.

  7. Entry Fees per team are as follows :

    1. Driver, navigator and 2 passengers @ RM 180 per person to stay over. Not staying over RM 100 per person

Entry Fees will entitle each participant to take part in the Hunt.

RM 180 : 1 night stay at Kampung Stay, tea session, Dinner & 1 breakfast.

RM 100 : 1 tea session & dinner for the prize giving ceremony.

    1. Please be informed that accommodation availability this time at Kampung Stay is on a first come first serve basis.

    2. The organizer reserves the right to allocate and assign accommodation for all participants.

  1. The decision of awarding prizes and points by the judges will be final.

  2. All payments by cash or cheques ( crossed ) made payable to HOSPIS MALAYSIA are to be deposited into MAYBANK account 5141-3212-1211. ( Please attach a copy of bank in slip with the entry form. )

  3. At least 1 team member from each team must attend the Registration and Briefing and he/she/they shall be responsible for disseminating all information provided at Briefing to all other team members.

  4. Competition numbers and various car stickers provided by the Organiser must be placed on participating vehicle as directed by the Organiser and must remain on the vehicle throughout the Hunt. No other form of advertising other than those provided by the Organiser shall be permitted.

  5. Participants are required to comply with the dress code for the Event as determined by the Organiser.

  6. All materials of whatsoever nature in relation to the Hunt (whether submitted as a treasure in the Hunt of otherwise) shall belong to the Organiser and no participant shall have any claim thereto.

  7. The Organiser shall be entitled to use any materials derived from the event in any form or for any purpose that the Organiser deems fit.

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