Event Registration Form

STEM Explorace Group Registration

12th January 2018 @ Putrajaya, Malaysia
For more information

http://razak.utm.my/superhero-run/
Team manager

First NameLast Name
IC / Passport No
E-mail
Gender

MaleFemale
Contact No.

Area CodePhone Number
Race

MalayChineseIndianOthers
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Details
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
Event Details
Category

A (AGE 7 – 12 YEARS) 1 KM STEM EXPLORACE GROUP of 5 pax - RM250.00 + Accompanying TeachersB (AGE 13 - 17 YEARS) 1 KM STEM EXPLORACE GROUP of 5 pax - RM250.00 + Accompanying Teachers
Teachers Name

First NameLast Name
IC / Passport No
T-shirt size

2XSXSSMLXL2XL
Student details
Student 1

First NameLast Name
IC / Passport No
T-shirt size

JSJMJLJXLXSSMLXL2XL
Student 2

First NameLast Name
IC / Passport No
T-shirt size

JSJMJLJXLXSSMLXL2XL
Student 3

First NameLast Name
IC / Passport No
T-shirt size

JSJMJLJXLXSSMLXL2XL
Student 4

First NameLast Name
IC / Passport No
T-shirt size

JSJMJLJXLXSSMLXL2XL
Student 5

First NameLast Name
IC / Passport No
T-shirt size

JSJMJLJXLXSSMLXL2XL
T-shirt Sizing Chart

Click HERE Sizing Chart For Junior
Payment should be made to the following account:

CIMB Islamic Bank Berhad
Acc. No. : 8603065170
Acc Holder : ARUS INFINITI SDN BHD

Fee for STEM Explorace Kids is RM 50.00 per student

A group of students is RM 250.00
Proof of payment details
Payment reference no.
Proof of payment

Browse Files

Cancelof
Note: Only .jpg, .jpeg, .png, .pdf formats allowed to a max size of 5 MB
Should be Empty:

STEM Explorace Group Registration

Emergency Details

Event Details

Student details

Proof of payment details