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Registration (*Deadline has been changed to 12th May 2017, 6PM. Please email togo817@togoparts.com for any enquiry)

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Date of Birth:*

Gender:*

Email:*

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Mobile Number:*

Pass Type

Free - No Physical Rewards
SGD9.90 - Medal only
SGD42.90 - Finisher Jersey only
SGD49.00 - Finisher Jersey + Medal only

School Name:

Matriculation No.:

Coupon Code:

Enter coupon code RM5-MY57 to get RM5 off the Medal + Finisher Jersey package by 13th September

Jersey Size:*

View Sizing Chart View Jersey in 3D

Referral Code:

If someone referred you to #TOGOMY57, please write down his/her username here. You too can refer someone and get yourself the Cyclodarity T-shirt for FREE by recommending at least 5 friends to join #TOGOMY57. Remember to ask them to list your username in their registration form.

Enter your Team name if you wish to aim for a Team Achievement. Minimum 5 members per team, if you are participating from Malaysia, please indicate the State your club/team is from.

Team Name

Team

MY57 STATE CHAMPION

Form a team to represent your state in this challenge. Team must have at least 5 members. The team with the longest average distance per member covered during the challenge period will get the honor of being named State Champion of #TOGOMY57! Participants to enter their state and team name in registration form.

Rewards will be mailed to the following address

Address:*

State/City:*

Country:*

Postal Code:*

Terms & Conditions

Completion of the entry form confirms the Participants agreement to abide by the Rules & Regulations here of the TOGOMY57 event.

Liability and Disclaimers

I fully understand and acknowledge the risks involved in my participation in the Event and I accept full responsibility and assume all such risks.

I Agree with the Terms & Conditions.

You have to agree to our terms and conditions.

= $reg_end_date && !$is_code) { ?> We have closed registration for #TOGOMY57! Email us feedback@togoparts.com if your registration didn't go thru. Secure Checkout */?>