IJN Run For Your Heart

PACKAGE TYPE

Package 1 (1 Adult + 1 kid)
Package 2 (2 Adults + 1 kid)

Personal Details (Package 1)

Adult Name *

IC / Passport no. *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone *

Gender *

Male
Female

Measurement Guide (Adult & Kids)

T-Shirt Size Adult *

Patient Name (Kid) *

MyKid / Passport no. *

Gender *

Male
Female

T-shirt size kid *

Personal Details (Package 2)

Adult Name 1 *

IC / Passport no. *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Gender *

Male
Female

Adult Name 2 *

IC / Passport no. *

Gender *

Male
Female

Measurement Guide (Adult & Kids)

T-Shirt Size Adult 1 *

T-Shirt Size Adult 2 *

Patient name (Kid) *

MyKid / Passport no. *

Gender *

Male
Female

T-shirt size kid *

CONSENT FORM

I certify that I am the parent/legal guardian of my child. As the parent/legal guardian, I acknowledge my responsibility for personal matters concerning my child. I hereby give consent for my child, to participate in this run, and I will assume full responsibility. *

Yes
No

Doctor Verification *

Click or drag a file to this area to upload.

EMERGENCY CONTACT

Name

Relation

No. Phone

PAYMENT METHOD

JomPay

Biller code : 9837

Ref-1 : IC participant

Ref-2 : RFYH2024

Total

RM0.00

Payment Receipt *

Click or drag a file to this area to upload.