| Entry Date : |
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| Yellow Chip Code : |
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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. |
| *Participate in : |
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| *Category : |
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* Participate in Marathon Please select Start Time |
An early start for marathon runners will be offered at 04:00 AM. Runners starting at 04:00 AM will appear in the result lists but are NOT eligible for top 3 trophies. Race staff and aid stations will be manned.
You MUST indicate here the time that you choose to start. A white BIB will be used for the 04:00 AM start and you will pick them up at the race kit pick-up like everyone else. |
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| Extra Pasta Party Ticket : |
*
(Adult) =
THB |
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*
(Child) =
THB |
| Farewell Party Ticket : |
*
(Adult) =
THB |
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*
(Child) =
THB |
*Given Name : |
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*Family Name : |
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*Nationality : |
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*Gender : |
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*Date Of Birth : |
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(dd - mm - yyyy) |
*Age
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(Age on 14 June 2009) |
*T-Shirt Size : |
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"Please provide full and accurate address details
as the organizers might need this for mailing your certificate" |
| *Address 1 : |
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| Address 2 : |
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| Suburb : |
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| State / Province : |
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| *Postal Code : |
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| *Country of Residence : |
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| *E-mail (First priority) : |
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| *Confirm E-mail (First priority) : |
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| Second E-mail : |
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| *Business Phone : |
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| *Direct Line : |
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| Private Phone : |
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| *Mobile : |
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| Facsimile : |
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| *Occupation : |
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| *Emergency Contact Person 1 : |
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| *Emergency Contact Telephone 1 : |
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| Emergency Contact Person 2 : |
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| Emergency Contact Telephone 2 : |
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| Overseas Airline : |
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| *Hotel in Phuket : |
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| Domestic Airline : |
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| Significant Athletic Accomplishment or Interesting Personal Story : |
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| Do you have any current medical problems or conditions for which a doctor is treating you ? |
Yes
No |
| Details : |
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| Are you allergic to any medications ? |
Yes
No |
| Details |
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| Do you wish the event medical staff to be aware of any specific medical problem ? |
Yes
No |
| Details : |
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| Remarks : |
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I certify that I am medically fit to compete 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. |
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(Before you register for the race, please read Race Rules) |
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