RACT Nomination Form

2018 INTERSTATE TEAM

Nomination Form

Nominations close at 5pm on 19/01/2018
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

SuburbState / Province

Post Code
E-mail
Phone Number
Date of Birth

MonthDayYear
Gender
Member Club
- Please Specify Club:
- Nominating as:
- Nominating for:
- Please include your current weight
  kg
- Prefered Sweep Side
- I with to be considered to cox the :
- Please include your current weight
  kg
- I with to be considered to coach the :
- Current NCAS Accreditation Level
- NCAS Accreditation #
- Please list four athletes you currently coach.
- Athlete 1
  
  First NameLast Name
- Athlete 2
  
  First NameLast Name
- Athlete 3
  
  First NameLast Name
- Athlete 4
  
  First NameLast Name
- In submitting this nomination I declare I have read the Rowing ACT Selection Policy, and the Rowing Australia Member Protection Policy, and agree to uphold the principles contained therein.
- Should be Empty: