Register for 2017 BTS Ultra

Take your time to fill in this registration form as accurate as possible.

Race Experience

Tell us, at least one race that you have completed. For 170KM, 102KM, and 70KM, this will determine if you qualify to enter. Our Race Director will review your submission, and only after Approval (and Payment) your participation will be Confirmed.

There is no qualification needed to enter 30KM, but if you have completed any race before, we'd love to know!
Race Completed (1):
Detail:
Result:
Optionally, upload your Result pdf|jpg|jpeg|png|gif|doc
Race Completed (2):
Detail:
Result:
Optionally, upload your Result pdf|jpg|jpeg|png|gif|doc

Personal Information

First Name
Last Name
Nationality
Passport/KTP Number
Passport/KTP Upload
Upload your Passport/KTP pdf|jpg|jpeg|png|gif|doc
IMPORTANT: We need this to apply for National Park Permit
Are you KITAS holder?
KITAS
YESNO
KITAS Number
KITAS Upload
Upload your KITAS pdf|jpg|jpeg|png|gif|doc
 
Date of Birth
format: example: 1985-12-01 for 1 December 1985
Gender
Blood Type
Event T-Shirt Size

Unisex Size Chart

Correspondence & Residential Address

Email
Same email can only be used for one runner
Mobile Number
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)
Address Line 1
Address Line 2
City
State / Prov
Country
Postal Code
In case of emergency, who should we contact?
Emergency Contact Name
Emergency Contact Number
Example: +6281212345678, +622198765432 Please include country code and area code (if applicable)

Lastly...

Sound Out
Agreement
IMPORTANT: This is a very challenging trail race. By registering for this event, you have read and agree to the conditions stated in the Terms and Condition, Rules & Regulations.
And you promise to train. HARD.
Fee in IDR Rp. 0.00

Bank Transfer to:
Bank Name: BCA (Bank Central Asia)
Account No: 7380322531
Beneficiary Name: Veronika

If the bank transfer form allows you to put Transfer Info (Keterangan Transfer), add your Reg ID ( (Reg ID will be emailed to you after you Submit this form)

Note: We need to receive the IDR amount as stated. You need to pay the full amount of bank transfer fee, if any.

Please email the transfer proof to [email protected], stating:
- Your Name
- Reg ID (Reg ID will be emailed to you after you Submit this form)
- Bank Account Name that you use to make the transfer, if it is different than your name.

Fee in USD $0.00

After your submission is submitted, you will be redirected to Paypal website, please proceed to make payment there, and once payment is completed, you will be redirected back to this site.

Pay By
Bank Transfer (IDR - Rupiah)Paypal (USD)