T ele/fax
:
Government of Odisha
and Youth Services Department
Sports
C-l, NaYaPalli, Bhubaneswar - 12
8 1' e-m ail :
067 4 -23g67 I 5 I 25367 i3 t isg o)$ n3902
No. -
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rx-sYs-cc-tlL5
/SYS
Bhubaneswar
Dated:
//,2-%ryf
From:
Sri
A.K.Jena
t
Director & Addl'Sg.Y
To
The Directo ,t/
Information & Public Relations
Odisha, Bhubaneswar
sub:
state capital'
- organization of Mini Marathon-2Ol"S at for
publication
Bhubaneswar on Sth March, 2ols-Request
of Advertisement'
Sir,
enclosing herewith a draft advertisement, I would
odiya dailies of
request you to kindly publish the same in three
of
All Odisha edition having highest circulation for information
news
the general public, complimentary copies of the concerned
this
papers publishing the advertisement may be sent to
In
Department for reference and record'
Yours faithfullY
NV
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Director a ed;I.'ftL!?tarv
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Memo
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of this Department to upload the
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Copy to JiI' Section
ad.vertisement in the departmental website'
Memo
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trl sys,
"". to ertt .ipal G.C.P.E,BBSR fOr information & necessary
copy
action.
z,(\ )
ecretarY
Director & Addl.
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BIJUPATNAIKMINI
MW
ENTRY FORM
l-. Name in Block
letters
:
2. Father/Guardians, Name
:
3. Sex
4. Mailing address
:
Contact No5. Previous experience in
Marathon Race if any
:
6. Present Age with Date of Birth proof
1-5-18 yea rs/a
7. For participation in
bove L8yea rs/Vetera
n
(50-60years Sr. Citizen 60Years)
(Please tick mark the
Appropriate category)
Full Signature of the ParticiPant
UNDERTAKING
..... do"hereby undertake to participate in the
MlNl MARATHON-2O13 to be held at Bhubaneswar on 5th March,2015 at my own risk. I also undertake
to abide by the rules and regulations framed by the organization for the purpose. I will not hold the
organization responsible for any mishap or accident during the course of participation in the marathon.
l,Sri/Smt/Kum................
Full Signature of the ParticiPant
FITNESS CERTIFICATE
is to certify that Sri/Smt./Kum................
Son /Daughter/Wife of
...has been examined by me and found to be medically fit to participate in the above
This
marathon. He/She is also found to be within the prescribed age group as stated in the serial 7 above.
Signature of the medical officer with (seal)
o6c.'€'l6d-'
e a6aG
qG)G)
el?rs.qa 6qG)l,(30€ll
€. e aqroql,qe6eqo