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Registration form for the Malaysia International Championship of Xtreme Skydive/World B.A.S.E. Cup 2004/05 Kuala Lumpur, Malaysia
 
Name :
Nationality :
Passport Number :
Age :
Profession :
Mailing Address  :
E-Mail Address :
Contact Number including international code :
Marital Status :
Single Married 
Number Of Child :
     
Contact of Next of Kin    
Name :
Relationship :
Contact Number including international code :
Mailing Address 
E-Mail Address :
     
BASE EXPERIENCE    
Total number of BASE jumps :
Buildings :
Cliffs :
Antennas :
Bridges :
Approximate number of slider up sub terminal delays? :
Approximate number of running launches? :
Who is a well known referee that will vouch for your ability? :
     
Have you competed before in MIXSA or SkyVenture Productions event?
Event Title :
Championship Title/Ranking :
     
BASE equipment    
Parachute :
Rig :
     
Medical information?    
Blood Type :
Allergies :
Pre existing condition :
Medication :
Insurance :
     
Information for commentary    
What other information about yourself would you like to be announced during competition? :
Skydive experience? (no jumps, accuracy, relative work, head down freestyle, instructor) :
Years in BASE? :
Years in Skydiving :
Special Skills? Wingsuit? Skysurfing? :
Why do you BASE jump? :
Greatest achievement or moment in Sport? :
Media Appearances? :
Most dangerous jump? :
Funniest moment? :
Anything unique to you? :
Other Sports? :
     
References:    
Please State Any Criminal Records that does not permit you to enter the country (if any): :
I agree that the above information is correct at the time of submission and if in any situation found to be untrue, the organizer remains the rights to reject the application. 
NOTE: All participants must have their own insurance coverage.
 
Enquiry Form

•

 APPLICATION FOR XTREME 
SKYDIVE/WORLD BASE CUP 2004/05

•

 APPLICATION FOR MR & MS XTREME FITNESS 2003


For information, please email to enquiry@xtremeskydive.com.my

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