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TYPE OF REGISTRATION

PAY TO: 

Beneterra Consolidated Corporation

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BDO - 4520137236

BPI - 1063273437

I hereby state that, 1) I have secured a clearance from a physician that I am physically fit to participate in the "SIKAD PARA SA SAKADA" in the city of Victorias, Negros Occidental, Philippines. 2) I have sufficiently trained for this event, 3) I give my consent to the free use of my name and picture in any broadcast, telecast and press release on the accounts of this event. Being aware of the risk involve and in consideration of the acceptance of my entry and the foregoing premises. I, together with my heirs and successors, hereby forever discharge, release, waive and quit claim any and all causes of actions, whether civil or criminal against the sponsors, their officers, and race organizers from any injury, sickness, death, accident, and damages that I may suffer or sustain by reason of this race.

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