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Entry Form (Please Write Clearly) Or-sanizers ; nd f'.lCulty of ~m:u.T1l1t11rJ~1a~i lIM1'Tmni~~~~1~~1lTfjiIfst Name ~ . Medl

Last Name.......... .. .

Dale of Bhth Month Year ..

A~ (201:3 - Year oJ Birth) ..

Mahidol Day Run 2013

Ivhni Marathon 00.5 km.) startin~ time 6.00 a.m.

run Run (4 km.) startir1~ time 6.10 a.m.

Men Women 0 Up to 16 years old o Up to 16 years old

o H-29 years old o 17-29 years 01(1'

o 30-39 years oldo 30-34 years old

o 35-39 years old o 40-49 years old

o 40-44 years old o 50-59 years old

o 45-49 years old o 60 years old and over

o 50-54 years old o Med PSU personnel

o 55-59 years old

o 60-64 years old

o 65-69 years old

o 70 years old and over

o Med PSU personnel

Declaration

I OOdare that the above stJlem~f'lt is factually tr~J~ and

that I have beel1 practll:inq ror the event tn"s being perfecHy fit

and WIth doctor's iJerml!>J-:Dn and reilOy to enter the race in ttl'" event

<IS stated in the application I wjllln~y piltticipatl! In the run and Will

not uernand or sue! for rpto.11pel1Sation ,1S a r~ult of mflt1o!lp cr

inJL.r1e~ eIther before. drter or duri~ the compel:tion arrl WIlt ~l.Jdl

prcdLA:e evidenuo! of birth if I finish in :DIy plac:e al'ledd of the race

in I:dt~ ~r<)up. Further l cor.soent to th,-, Or~anl.:in9 Commlltld€ IecorcLri~

the Lomrerllive evern tlvOt,lljtl photOgfOlphing ~~.O mrr.;~ af'd thilt

the cC1mrr,tlee is the 501.e OW!1!!1 or copyrlIJht to lt1l! ordures and

films

$rgflatl:Je... enlTnn t

Sl~nuture . (,uarci~n

(if lr.~~ lhan IS years old)

Race Day: Sunday ~ept('mber 8, 2013

Start/Finish Line: In front of the Medical Edllcation BwLdillV

Fdculty of Medicine, Prince of Songkla Unive~lty. Hat Yal , SG'l(khla

C:ate-sories ; Fun nJll £\ km. and Mini Marathon to.s km

Entry Fee: 200 bdth! pcrsor. (80th Fun Run or Mini Marathon)

How to enter the run: Fill out the entry form and submit with

\-!ntry fee to the officials near the Start-Finish line on Saturday

September 7, 2013 between 10.00 a.m. - 8.00 p.m. ilnd Sunday

September 8, 2013 between 4.30 a.m. - 5.30 a.m. on the race day.

All entrants will receive a tag number and a ~ood quality running

·C:;hirt~.

Services: Drinkin~ water will be served alon~ the funning route.

Usnt meal5 and drinkin~ water will be '""rved at the finishing area.

Bagsage deposit service will be available form 5.00 am-8.00 a.m.

Sporting ~oods will be on sale near the finlshin~ line. FiI~t-ai(l servlte

will be available at the fini,hinp, afea and illon~ the route.

Important Note : All winners must show proof of their

bil lhdate (passpClrl or i.d. card) WIthin 20 minutes aier entenn~ the

f1nrshll1~ line.

Prizes: E..10l pa\:dpant will receive a medal. In the 10.5 km.

run, the I" to 1Oth p(ace winners (men and ,;,/Omeo) of e2!ch JQ

group win receive a trophy

Contact : teL 074 45-1142, 074- 451145

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