INTERHASH '98
REGISTRATION FORM

Dates: 2nd/3rd/4th October, 1998
Please send to:-

INTERHASH '98
c/o P.O. Box 13603

50816 Kuala Lumpur. Malaysia.
Tel:(+603) 242-9798 Fax:(+603) 242-9796
email: [email protected]


Please print out the form (or dowload it as a Word document) and complete in BLOCK CAPITALS � Name:- _________________________________________________ Sex:-__________ � Address:-_______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ � Country:- ______________________________________________________________ � Phone:-________________ Fax:-________________ E-mail:-__________________ � Nationality:-________ Passport No:-__________ Date of Birth:- _______ � Home Hash:-________________________ Hash Name:- ________________________ � Does your Hash wish to contribute a Hash act? ( )1st Night ( )2nd Night ( )3rd Night � Are you the Voting GM of your Hash, for the Interhash '98 Delegates Meeting? Yes / No (Circle) � Circle previous Interhashes attended ... '78/ '80 / '82 / '84 / '86 / '88 / '90 / '92 / '94 / '96 � Circle T shirt size 38", 40", 42", 44", 46", 48", 50" ... Circle preferred run length S(45 min), M(1 hr. 15 min.), L(2 hrs.) �
� Registration Fees:- For registrations received between January 1st 1997 and December 31st 1997 Personal Cheque US$157 Bank Draft Money Order US$150 � For registrations received between January 1st 1998 and August 31st 1998 Personal Cheque US$210 Bank Draft Money Order US$200 � For registrations received on or after September 1st 1998 Personal Cheque US$262 Bank Draft Money Order US$250 � I enclose my Bank Cheque / Bank Draft / International Money Order*, made payable to INTERHASH '98 No _______________ for US$_________________ Dated___________________ � Please debit my Master Card A/C (only Master Card Cards Accepted) Issuing Bank ____________________________________ � No. | | | | |x| | | | | |x| | | | | |x| | | | | | � For US$______________ Expiry Date:______________ � � Please note that we will take the usual strict line with late, or incomplete registrations.
THE FINE PRINT

I understand that my consent to these provisions is given in consideration for being permitted to participate in this event. I am aware of, and voluntarily assume the risks of coming to this event. If I am injured, I agree that I will not sue, or otherwise hold responsible,The Interhash '98 Organising Committee,or any affiliated individuals,or any run sponsor and/or their employees. In other words, I take responsibility for my own actions and I will not try to screw anybody connected with this event-and maybe, for the first time in my life,I will be responsible for myself and my actions.

Signature_______________________ Date______________ �

(Please not that this form is not valid without a signature

and a date, and full payment of registration fees)


� For Official Use only: Date received_____________ Date entered________ Reg. No:____________ Remarks: ___________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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