Individual Registration

Please enter information in the form below to process registration for event RHB LEKAS Highway Ride 2024 (105km).

Name *

Gender *

Male

Female

IC / Passport *

Date Of Birth (DD-MM-YYYY) *

Age *

Age is computed based on 2024 - birth year: eg. 2024- 1997= 27

Category *

Club Name

Nationality *

Address *

City *

State *

Postcode

Contact No *

Email *

Average Cycling Speed (km/h) *

Blood Type

Jersey's Option *

Yes, I want a Jersey

No, I do not want a Jersey

Jersey Size *

Emergency Contact Person *

Emergency Contact No *

Relationship *

Coupon

Amount

Discount Amount

Gross amount

Payment Method

Ipay88 Online Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

By registering for this event, I acknowledge the waiver clause stated therein, accepting the Rules & Regulations