PDF《中国香港单车联会有限公司》

Affiliated Club's Name 属会名称: Team Manager's Name Tel No.

领姓名: 联络

电话: Declaration 声明 Name of Rider (English) 姓名(英文) Name of Rider (Chinese) 姓名(中文) D.O.B (DD/MM/YY) 出生日期 Category 参加组别 Extra events 加报组别 Pick up Point 上车地点 Entry Fee 费用 Rider's Signature 运动员签名

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19 20 Total: 总费用: Chequre No. 支票号码: Recepit No. 收怕: Date 领签名: 日期: Email 电邮 : Paid by Cheque 支票付款 支票祈付"The Cycling Association of Hong Kong, China Limited" (并於背面写上参赛者之姓名及联络电话) 中国香港单车联会有限公司 The Cycling Association of Hong Kong, China Limited RACE ENTRY FORM FOR AFFILIATED CLUB 属会比赛报名表 18岁以下之参加者必须填写个人报名表. 2015年3月29日Samsung 第58届体育节 - 全港青年公路冠军赛 大埔 新娘潭 2015/3/29 Samsung 58th Festival of Sport Hong Kong Youth Cycling Championships , Bride's Pool Road, Tai Po #Riders can participants either Challenge OR Open #参赛者只可选择参加挑战组或公开组其中一组 公路车比赛报名表与报名费必须於2015年3月19日 下午6时前递交,方为有效.不设即场报名. Team Manager's Signature All information given in this entry form is correct, complete and true to the best of my knowledge and belief. I certify that I am entering this race at my risk and responsibility. I agreed to abide by the regulations, policies and anti- doping policy of The Cycling Association of Hong Kong, China Limited. I for myself, my executors and administrators, do hereby waive and release, any and all rights, claims and causes of action I have or may have against The Cycling Association of Hong Kong, China Limited and all sponsors, promoters, supporters and all other contributors from any and all liability arising from illness, injury, death, loss and economic consequences I may suffer as a result of my entry in this event from any cause whatsoever, including negligence. I certifiy that I am physically fit and sufficiently trained to compete for the completion of this event. I grant permission and assign all rights, title and interest to the organizer to utlize my appearance, name, voice biodata and likeness in connection with the race in any and all media throughout the world in perpetually and agree to waive any rights of inspection or approval associated. 就本人所知所信,在本报名表内所\报的各项资?均属正确、完备和真实.谨证明本人是自愿参加比赛,并愿意自行承担所有责任.本人亦谨遵守赛会之一切规则、决定包括药物检查条例.本人、本 人之继承人、本人之遗嘱执行人及本人之管理人谨此豁免中国香港单车联会有限公司,所有赞助商、支持是项活动之团体及任何有关之团体对於本人因参加是项比赛而由任何原因,包括疏忽,所引致 之疾病、死亡、个人损失之任何法律责任,以及放弃任何有关之权利、索偿及追究行动.本人亦同时声明本人身体状况良好及具备足够训练完成赛事.本人愿意授权大会及传媒在无须本人审查而可以 使用本人的肖像、姓名、声线及个人资料作为活动筹办及推广之用. Remark备注 Individual Entry Form shall be completed for participants aged under

18 years. The enrolment deadline for Road races will be 2015/3/19 18:00 . Entry form(s) and entry fee(s) must be reached to HKCA on or before the deadline. No on-spot enrollment.