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2013 Australian Youth Olympic Festival - Athlete Nomination Form

Nominations close 5.00pm, Friday 23 November 2012 

First Name:*
Surname:*
Full Address:*
Suburb:*
Postcode:*
Athlete Mobile:*
Athlete Email:*
DOB:*
Club/School:*
Coach:*
Zoot Suit, Polo Shirt, Shorts Size:*
2012 Best 2000m Erg Score (Concept 2)
Highest Level of Representation
   
Nominating As:* Heavyweight
Lightweight
Coxswain
Nominating for: Scull
Sweep Oar (Pair)
Both Scull & Pair

If you select sweep, please indicate pair partner:
Medical Condition or Dietary Allergy:*
Who is submitting this online nomination? (Athlete or Coach name)
Emergency Contact Person:*
Emergency Contact Relationship:*
Emergency Contact Mobile:*
I acknowledge that if selected a $250 Seat Fee will apply. Yes
No

I (or the person nominating me) declare that the
information stated in this form is true and agree to
abide by all relevant RNSW Policies & Rules and
am not aware of any injuries that will limit my
participation in the selection trials, training camps
or the 2013 Australian Youth Olympic Festival, and
am able to fully participate in all requested activities
listed in the key dates.

 Yes
No
 
 
  

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