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Event Template 2 -Form Fill

Section One
Q1

NAME OF THE RIDER*

First Name
Q2

NAME OF THE RIDER*

Middle Name
Q3

NAME OF THE RIDER*

Last Name
Q4

Address*

Street Address
Q5

Address*

Brgy
Q6

Address*

Town / City
Q7

Address*

Province
Q8

Address*

Postal / Zip Code
Q9

BIRTH DATE*

Month
Q10

BIRTH DATE*

Day
Q11

BIRTH DATE*

Year
Q12

GENDER*
Q13

SHIRT & VEST SIZE*
Q14

MODE OF PAYMENT*
Q15

I hereby waive, renounce, quitclaim and forego any of and all my rights of action against any of and all the organizers, if any, in connection with my participation in Isle of 8 endurance challenge which might arise in case of road accident during the conduct thereof. I fully understand that my participation in said event is voluntary on my part and in accordance with my own volition and freewill.*
Q16

Signature*