|
Given Name
|
| |
Kenny Chia
|
|
Family Name
|
| |
The Chia'z
|
|
Nationality
|
| |
Malaysia
|
|
IC No./Passport No.
|
| |
840821055079
|
|
Date of Birth
|
| |
08/21/1984
|
|
Gender
|
| |
Male
|
|
Address 1
|
| |
1187 , Jalan Bukit Galena 21
|
|
Address Line 2
|
| |
Taman bukit galena
|
|
Post Code
|
| |
70,200
|
|
State
|
| |
Negeri Sembilan
|
|
Country
|
| |
Malaysia
|
|
Contact No. (ex: 6012345678)
|
| |
0124440398
|
|
Email
|
| |
barnaked2003@gmail.com
|
|
Event-T Size
|
| |
Adults-M
|
|
Emergency Contact Number (ex: 6012345678)
|
| |
0162888474
|
|
Given Name
|
| |
Kenny
|
|
Family Name
|
| |
Chia
|
|
Nationality
|
| |
Malaysia
|
|
IC No./Passport No.
|
| |
160117050267
|
|
Date of Birth
|
| |
01/17/2016
|
|
Gender
|
| |
Male
|
|
Address 1
|
| |
1187 , Jalan Bukit Galena 21
|
|
Address Line 2
|
| |
Taman bukit galena
|
|
Post Code
|
| |
70,200
|
|
State
|
| |
Negeri Sembilan
|
|
Country
|
| |
Malaysia
|
|
Contact No. (ex: 6012345678)
|
| |
0124440398
|
|
Email
|
| |
barnaked2003@gmail.com
|
|
Event-T Size
|
| |
Kids-S
|
|
Emergency Contact Number (ex: 6012345678)
|
| |
0162888474
|
|
Agreement
|
| |
 I agree to the privacy policy.
I have read and agree to abide by the Event Registration Rules & Regulations of Matrix Duathlon 2023.
|
|
Order
|
| |
| Product |
Qty |
Unit Price |
Price |
|
Matrix Duathlon Family Relay
|
1 |
RM 80.00 |
RM 80.00 |
| |
Sub Total |
RM 80.00
|
| |
Total |
RM 80.00 |
|
