Back in Melaka! (14-15 May 2022) Full Name *Mobile Number *Email Address *Date of Birth *Day *Month *Year *Blood Type *Please SelectA+A-B+B-AB+AB-O+O-AllergiesPlease indicate the food / medicine allergies that you haveName of Next-of-KinNext-of-Kin Contact #Next-of-Kin RelationshipPlease SelectSpouseFamilyFriendOtherAre you bringing a guest? *Please SelectYesNoNo. of Guests who are MembersPlease Select0123No. of Guests who are Non-MembersPlease Select0123Membership No. & Name of Guest(s):Please indicate the Membership number(s) and Name(s) of your guest(s)Name of Guest(s)Please indicate the Name of your guest(s)Total PaymentSGDParticipant's Declaration *I acknowledge that neither KRUZER, its officers, leaders, agents or assistants will not be responsible for any injury that me (and/or my guest) may sustain as a result of me (and/or my guest's) participation in club activities. I (and/or my guest) hereby agree to indemnify and keep indemnified it and them against any claim by me or on my behalf in relation to any injury or damage I may sustain to my person or property as a result of such participation.Send Leave a Reply Cancel replyYour email address will not be published. Required fields are marked *Comment * Name * Email * Website Δ This site uses Akismet to reduce spam. Learn how your comment data is processed.