FRANCE EXCHANGE | July 2018 (2 weeks, dates TBA)
NOMINATION FORM DUE DATE: 10th February 2018
The following information must be your legal name as represented on your passport. The information you provide will be used to purchase airline tickets, insurance and any travel bookings.
Competitor’s Details
State Association: Competitor’s Club:
Full Name:
Postal address: Postcode:
Residential address: ………………………………………………………………………………………………………………………………………………………
Date of Birth: ……………………………………… Age at 1st Jan 2018: (17, 18 or 19 years)
PH(H): PH(M):
Email:
Travel Details
Closest domestic airport:
Team member will need to have a valid Passport with an expiry date of April 2019 or later
Parent’s/Guardian’s Details (Emergency Contacts)
Parent/Guardian: Relationship:
PH(H): PH(M):
Email:
Parent/Guardian: Relationship:
PH(H): PH(M):
Email:
Cost of tour: $5000 (estimate)
Bank details for EFT payment of the tour costs will be sent to you when the team is confirmed. Cheques not accepted.
Please identify who will be paying the invoice (delete which one does not apply) – Competitor or State Office
ENDORSEMENT OF STATE ASSOCIATION
We have pleasure in nominating to represent our State and Australia.
President: Date:
CEO/State Coach: Date:
COMPETITOR PROFILE - FRANCE DUE DATE: 10th February 2018
Please attach a jpeg passport style photo, head and shoulders.
Full name:
Sport
Coach name: Favourite discipline:
When did you start riding? When did you join Pony Club?
Why have you chosen to apply?
Which National and International events have you participated in? (year/event/name):
What would you like the selection committee to know about you?
General
Ambitions:
Awards/Honours:
Efficiency Certificates achieved: £ A £ B £ K £ C* £ C £ D £ D* £ E (Must have B certificate)
Other Pony Club achievements:
School/ academic achievements:
Hero/Idol:
Other Hobbies:
State, National and International Showjumping or Eventing Competition Results
Year / Event / ResultPlease attach another sheet if necessary
Return this form to:
| P: 03 95965390
Acknowledging the financial support of the Australian Sports commission