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SENTUL RUNNERS

SPEED RUN ANNIVERSARY - 400 Meter Single

Nama Lengkap

Full Name

No HP

Phone Number

Email

Email Address

Jenis Kelamin

Gender

Golongan Darah

Blood Type

Nama Kontak Darurat

Emergency Name

Kontak Darurat

Emergency Contact

Upload Bukti Pembayaran / Upload Proof of Payment

Detil Pembayaran / Payment Details:

Peserta Individu / Individual Participant: Rp89,000/person Akun BCA / BCA Account: 7475 44 6747 Nama Akun / Account Name: Julli Indriati

Pernyataan tentang kondisi pelari dan resiko / Runner's Health Condition and Risk Acknowledgment

Saya menyatakan bahwa saya sehat dan layak mengikuti event Sentul Runners Speed Run Anniversary, serta bersedia mengikuti seluruh aturan dan regulasi acara.
I hereby declare that I am in good health and fit to participate in the Sentul Runners Speed Run Anniversary event, and I agree to comply with all event rules and regulations.