2^nd Karangasem - Bali International Marathon

Candidasa, 23^rd April 2000

E-mail : balimarathon@mailcity.com or mekardps@denpasar.wasantara.net.id

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OFFICIAL ENTRY FORM

LAST NAME (FAMILY NAME):

FIRST NAME :

MALE / FEMALE :
Male Female

ADDRESS:

CITY:

COUNTRY:

PHONE NUMBER :

FAX NUMBER :

E-mail Address:

ZIP CODE :

PLACE OF BIRTH :

AGE :

_{DATE of BIRTH :}
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I Want to Join :
Select One Race Category ! FULL MARATHON (US$ 75) HALF MARATHON (US$ 65) 10K (US$ 55)

Do You Need any Further Information ? Please Type Your Inquiries here !

IMPORTANT !!!

Please read the following information carefully before you submit your registration !

For Overseas Entrants we will receive your payment by credit card only. In connection with security reason, we need you to fax your credit card details (Card - type, Name on Card, Expiry Date and Signature) to our office fax number 62 - 361 - 722905.

We will process your registration after we received your completed entry form and your credit card details facsimile.

You will receive a confirmation from us through e-mail or fax within a week after we received your completed entry form and your credit card details facsimile.

If you wish to use other payment method please contact our office or AustrAsia Tours , Feldstraße 21 35094 Lahntal - Caldern Germany

Phn 06420-310 / Fax. 7844

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Mekar Wisata

Sengkidu, Candidasa - Bali

AustrAsia Tours Germany

Office : Mekar Wisata Tours & Travel

Jl. Kertapetasikan XII / 26, Suwung Kangin Denpasar

Ph. 62 - 361 -722905 / 725338 Fax. 62 - 361 - 722905

Contact person : Iwan Wahyudi / Arry / Firda Yussnita

E-mail : balimarathon@mailcity.com or mekardps@denpasar.wasantara.net.id