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GIETMAN ROAD BIKE SERIES 2 – 2018

Attention:

  1. Please read carefully GIETMAN Road Bike Rule before submit at http://mtbman.org/programs/
  2. I have read the rules of GIETMAN Road Bike and accept them without reservation
  3. Fill out the Form online with your email account, Immediately make a transfer payment in the account listed & attach evidence of transfer. By completing the form and transfer payment you will get a reply email from the committee for confirmation has fulfilled the registration requirement and officially become the participant.
Register time and Entry Fee periode:
Period 1: 01 October – 30 November 2018 / IDR. 300,000 * IDR. 200,000 (BALI ID) * Student / IDR. 100,000
Period 2: 01 – 10 December 2018: Rp. 400,000
Stater Kits Pick up : Saturday, December 22nd  2018   13:00 PM to 16:00 PM
Race : Sunday, December 23rd 2018
Entry Fee including : Starting Kit, Refreshment, Lunch Box, Medal Finisher, Lucky Draw.

Transfer address :

Bank Indonesia Account : Bank Rakyat Indonesia, Kantor Cabang Kuta

Jl. Dewi Sri No. 99X – Kuta – Badung – Bali – Indonesia

Swift Code : B R I N I D J A

NAME : YAYASAN ATLIT NUSANTARA

ACCOUNT NO. : 055 601 000 699 309

………………………………………………………………………………………………………………………………………………………………………………

Your Name (required)

Evidence of transfer code (required)

No KTP / Pasport (required)

Your Email (required)

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Nationality

Sex

Date of birth (DD-MM-YYYY)

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