TREE CLIMBERS MALAYSIA

Malaysia Tree Climbing Championships

8th to 10th April 2016

Climber Entry Form and Waiver This MUST be completed and submitted with your payment before 28th March 2016. Applications to Tree Climbers Malaysia, Email: treeclimbersm@gmail.com or by Post: H-04-02 Jalan CU/A1 Taman Cheras Utama, 56000 Cheras, Kuala Lumpur MALAYSIA.

Name

Date of Birth

Organisation

Emergency Name: Address: PH:

Contact

Country

State Post Code

Postal Address

Telephone ( ) Mobile

E-mail

Entry Fee

Malaysia Tree Climbing Championship(MTCC) 2016 RM280.00

Shirt size:

Association name and Membership number (if applicable)

Method of Payment: Cheque (Bank cheque/money order)

Online payment: via Maybank2u.com.my

Cash (Make payment on event day)

Make payment to Xtree Resources. (Maybank:562106726334)

Please provide a brief description of competition experience, ranking and current employment.

56000

TREE CLIMBERS MALAYSIA

MALAYSIA TREE CLIMBING CHAMPIONSHIPS (MTCC) 2016

RULES AND REGULATIONS

1. By taking part in the MTCC, you undertake to obey the rules as set out herein and in paragraph 2 below (the Rules). 2. The following Rules apply to all events in the MTCC 2015 and you shall comply with them:

(i) The competition rules of the International Tree Climbing Championships (English version, revised June 11

2014) by the International Society of Arboriculture. The complete sets of Rules are available at:-

http://www.itcc-isa.com/resources/rules_2014RuleBook_Final.pdf you will be deemed to have read and

(ii)

familiarized yourself with the Rules and;

To be an eligible participant for Malaysia Tree Climbing Championships, you must be (a) a member of

Tree Climbers Malaysia (TCM) or; International Society of Arboriculture Society (ISA) and (b) must have

successfully completed WSQ Basic Tree Climbing Course or equivalent or must have competed

(iii)

previously in a MTCC, STCC or APTCC or any tree climbing competition.

Eligible competitors must complete and submit the official Climber Entry Form and Waiver to Tree Climbers

(iv)

Malaysia (TCM) on or prior to the closing date as specified by the MTCC 2016 official organizer.

Eligible competitors must make full registration payment to Xtree Resources (Appointed company to

received all kind of payment or sponsorship for MTCC 2016) prior to the competition date as specified by the MTCC 2016 official organizer

3. The Tree Climbers Malaysia (the Organiser) reserve the right to amend the Rules at any time, or to implement any

other rules or instructions for the general safety of all participants. 4. You understand and accept that participation in the MTCC 2016 may involve certain risks and dangers that may result

in serious injury, paralysis, disability or death and you hereby freely and voluntarily assume all risks and undertake

responsibility for your own health and safety during the MTCC 2016.

5. You understand and agree that the Organiser and their employees or agents shall not be liable to you or anyone

entitled to claim through you for any injury (including death, paralysis or disability) or damage or loss of your property

sustained by you, in connection with or in the course of your participation in the MTCC 2016, and you hereby waive all

your rights against the Organizers.

6. To participate in the MTCC 2016:-

(i) You must comply with all the requirements in the competition rules of the International Tree Climbing

Championships (English version, revised June 11 2014) by the International Society of Arboriculture.

(ii) be sufficiently physically fit to compete safely in this event and you must not have been advised otherwise by

a qualified doctor

(iii) you must be appropriately attired and wear proper safety and protective gear during the event

(iv) agree to the terms of and sign the Disclaimer and Indemnity Form, and;

(v) Submit the Application Form together with payment, the Disclaimer and Indemnity Form and the Certification,

Waiver and Indemnity Form by Employer all duly completed and signed by the Registration closing date or

prior to the even as set out by the official organizers.

TREE CLIMBERS MALAYSIA Disclaimer of Liability and Indemnity Form

1. I, ____________________ (name), having Passport number ________________,

2. I fully recognize and accept that any outdoor activities such as the events in the MTCC 2016 that involve substantial

and physically testing obstacles may involve certain dangers, including but not limited to the forces of nature,

unforeseeable failure of equipment and my own actions; and that participation in the MTCC 2016 may be dangerous

and involve risks and dangers that may result in serious injury, disability, paralysis or death to myself or other persons

participating in the MTCC 2016. 3. I declare that I am physically fit and I certify that to the best of my knowledge, I do not have a medical condition which

might have the effect of making it more likely that I will be involved in an incident which could result in injury to myself or

others. 4. I further declare that my participation in the MTCC 2016 is undertaken freely and voluntarily by me at my own risk. I

recognize and fully assume all risks and dangers involved in my participation and will not under any circumstances rely

on the care, judgment or assurance of anyone other than myself for matters relating to my own safety. 5. I agree that I am responsible for my own safety (and the safety of my possessions) and will not hold the Organiser

responsible for the consequences of my participation in the MTCC 2016, including any injury (including disability, death

or paralysis), damage to or loss of property sustained by me or for any loss, damage, expense or costs sustained by

me or arising out of my participation in the MTCC 2016.

6. In consideration of the Organisers acceptance of my application for entry as a participant in the MTCC 2016, I hereby

(i) declare that I will not hold the Organiser or any of their employees or agents liable for any personal injury to

me (including disability, paralysis and death), or property loss or damage (including to my equipment);

(ii) waive any and all claims I may have at any time, or any and all claims which might otherwise be made by, or

on behalf of, or on account of me, or by any person or entity in any way (whether under the right of

subrogation or otherwise), against the Organiser and their employees or agents, howsoever arising on

account of or in consequence of my activities or participation in the MTCC 2016, or in any other way related to

the MTCC 2016, whether arising in tort or contract; and

(iii) undertake that I will, at all times sufficiently indemnify and keep the Organiser indemnified against any claim,

action, loss, costs and expense in respect of personal injuries sustained by me or damage to my property

caused by or arising from or in any way related to the MTCC 2016.

Participants Name and Signature Date:

___________________________ _________________

TREE CLIMBERS MALAYSIA

MALAYSIA TREE CLIMBING CHAMPIONSHIPS (MTCC) 2016 DEED OF CERTIFICATION, WAIVER AND INDEMNITY BY EMPLOYER

Full Name of Employer: Place of incorporation: Mailing Address / Place of Business: Contact Telephone Number: Facsimile Number: Email Address:

1. I, ___________________________ (name in full), declare that I am a representative of the Employer named above and

that I am duly authorised to sign and execute this Certification, Waiver and Indemnity Form for and on behalf of the

Employer, and that all necessary resolutions have been duly passed and adopted by the Employer.

2. I certify that: (i) the Employer is aware of and agrees unconditionally to the Employee,

________________________________ (name in full), taking part in the Malaysia Tree Climbing Championship

2016 (MTCC 2016); and (ii) the Employer is also aware that the Employee is required to and has signed the Disclaimer of Liability and

Indemnity Form and has no objections thereto.

3. The Employer hereby waives all and any subrogation rights or claims that the Employer may have against the Organiser

of the MTCC 2016, namely the Tree Climbers Malaysia and their employees, arising from any compensation or other

benefits or expenses incurred or paid by the Employer, its insurers or otherwise on its behalf, in the event of any claim or

injury to the Employee arising from the Employees participation in the MTCC 2016.

4. The Employer agrees to indemnify and keep fully indemnified the Organiser of the MTCC 2016 from and against all

claims, demands, actions, suits, proceedings, liabilities of any kind, judgments, damages, costs, losses and expenses of

any nature whatsoever which the Employer may suffer or incur in connection with the loss of life, personal injury

(including disability or paralysis) and/or damage to property arising from or out of the Employees participation in the

MTCC 2016. _______________________________________ Name/Signature of duly authorised representative

Date: _________________________ Employers stamp/chop