Laguna Phuket Triathlon
6 Km Fun Run Registration

6 Km Fun Run
01 April 08 - 31 October 08
Thai / Non-Thai Athletes
THB 400.-

ONLINE REGISTRATION FORM ( Fields marked with * are required )
Entry Date :
Yellow Chip Code :
Please fill in your yellow chip code if you have one. If not, put dash ("-") in this field. We will provide you with a chip for the race.
*Category :
Male 12 years & Above
Female 12 years & Above
* Given Name:
* Family Name:
* Nationality:
*Gender:
*Date Of Birth : - - (dd - mm - yyyy)
*Age : (Age on 7 December 2008)
*T-Shirt Size :
*Address 1 :
Address 2 :
Suburb :
State / Province :
*Postal Code :
*Country of Residence :
*E-mail (First priority) :
*Confirm E-mail (First priority) :
Second E-mail :
*Business Phone :
*Direct Line :
Private Phone :
*Mobile :
Facsimile :
*Occupation :
*Emergency Contact Person 1 :
*Emergency Contact Telephone 1 :
Emergency Contact Person 2 :
Emergency Contact Telephone 2 :
Overseas Airline :
Hotel in Phuket :
Domestic Airline :
Significant Athletic Accomplishment or Interesting Personal Story :
Do you have any current medical problems or conditions for which a doctor is treating you ? Yes
No
Details :
Are you allergic to any medications ? Yes
No
Details
Do you wish the event medical staff to be aware of any specific medical problem ? Yes
No
Details :
Remarks :
I certify that I am medically fit to complete and fully understand that I enter at my own risk, and the organizers will in no way be held responsible for any injury, illness of loss, during or as a result of the event.
 
 
 

(*Registration for events, online registration forms can function properly only on Internet Explorer and Safari*)

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