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UTAR‐GTI Media: M100 Challenge Registration Form Date: 13 June 2015(Saturday) Time: 7.30am Venue: UTAR Perak Campus Registration Fee: RM 50 per team (6 persons, each team must have a minimum of two (2) female participants) Deposit: RM 50 per team (refundable) Transportation provided for UTAR Sg. Long City Campus participate Team to Perak Campus No. Name
IC Number Gender
Course & Year/Semester CGPA
Email Address
T‐Shirt Size Contact Number
Emergency Contact (Name & Contact Number) 1 2 3 4 5 6 Things you will get:  Contestant will be given a set of race kit & sports attire which needs to wear during event day. Collection date and time will be notified via email.  Water supply on every challenge booth.  Light Lunch provided. Things to do:  Fill up the team application form with each individual’s CV attached.  Each team member must have his/her own bicycle in order to participate in M100 Challenge.  Each team member will need to undergo an assessment test to qualify for the event. Details of the test will be notified via email. Only successful team will be eligible to participate in this event. Full refund will be returned for unsuccessful team.  Be focus, passionate, energetic to enjoy the challenge and grab the golden opportunity to show your talent to your future employer. DISCLAIMER CLAUSE The University and Organiser are not responsible for any death, injury, loss or damage of any kind suffered by any person while participating in this challenge and all related activities of the challenge including injury, loss or damage which might be caused by the negligence. THE RELEASEES includes cycling from the station to station for the whole challenge and other activities as determined by the organiser. Signature of Participant ______________________________________________________ Date _____________________ Organized by Department of Alumni Relations and Placement