马拉松报名表

第9届“万科杯”南宁国际半程马拉松个人报名表

The 9th “Van Ke Cup” Nanning International Half Marathon Individual Entry Form

半程马拉松 Half Marathon 10公里 10KM √ 4公里 4KM 老年人健身走 The Elderly Fitness Walking √ 姓名 Name 身份证 I.D.Number 男 Male 女 Female 出生年月日 Date of Birth 国家/地区 Nationality 4508811 中国南宁 单位地址、邮编 Company's Address and Postal Code 南宁市西乡塘区大学东路100号广西大学 530004 15678882890 血型 Blood Group B 家庭住址 Home Address 最好成绩 Best Result 广西南宁市西乡塘区 联系电话 Tel.: 邮编 Postal Code 530004 无 比赛名称 Name of Event 十公里 日期 Date 2014.10.30 1

本人声明： 1、我自愿参加第9届“万科杯”南宁国际半程马拉松比赛暨32届南宁解放日长跑活动，并明白参加此项比赛对健康状况有特殊要求以及潜在的不安全因素。 2、我自觉严格遵守本届比赛大会的所有规定，为参加比赛已做好充分训练和准备，本人已经医疗机构体检，身体健康，有能力参加此活动。愿意承担自身的意外风险责任，并无权向大会对本人在活动中发生或引致的自身意外、死亡或任何形式的损失索赔或追究责任。 3、本人在此比赛中的姓名、照片、声像愿意无偿提供给大会宣传所用。 1. I apply to participate in the 9th “Van Ke Cup” Nanning International Half Marathon Race & the 32st Nanning Liberation Day Long-distance Race of my own free will, and I am aware of the special requirement for the health condition and potential risks involved in these events. 2. I agree to abide by and follow the rules established by the organizing side, and have made full preparation and training for the race. I have gotten a medical checkup from the medical institution and been proved to be health and capable of participating in these events. I voluntarily assume all the risks occurring during the Event and agree that the organizing side is not responsible for any compensation and liability of the injuries, death or other forms of loss. 3. In relation to the races the organizing side and the designated media are entitled to use my portraits, name, voice and other personal information free of charge for the organizing and popularization of the Event. 参赛者签名 日期 Signature of Participant : ________________ Date: ____________________ 监护人签名(参赛者年龄不满18岁)： Signature of Guardian (for participants younger than 18 years old) ： 监护人身份证号码： Guardian’s ID (passport)Number:

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