Application for International Scoring Appointment for 2018

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Name: / Accreditation Level: / Level4566 ISF78
Residential Address:
State: / SelectACTNSWNTQLDSATASVICWA / Post Code:
Delivery Address:
SelectACTNSWNTQLDSATASVICWA / Post Code:
Telephone:
(inc area codes) / Home / Work or Mobile:
Date of Birth:
Email:
Passport #:
Place of Birth: / Nationality:
QANTAS Frequent Flyers / Virgin Velocity #:
  1. Application –Applicant can apply for one or more tournaments on this application.

International Event / Dates / Location
XII WBSC Junior Men’s Softball World Championship / *7-15 July 2018 / Prince Albert, SK, Canada
XVI WBSC Women’s Softball World Championship / *2-12 August 2018 / Chiba, Japan
  • All non WBSC Championships are user pay
  • The above dates are tournament dates only; departure date will depend on pre tournament itineraries.
  1. Supporting Information

What skills and experience can you bring to Softball Australia relevant to this position?
List other softball positions or responsibilities held (please indicate year)
National
State
Association
Club
Other sports or organisations
Additional information (optional)(if insufficient space, please attach additional details)

Applicant Declaration

I, [insert name], make the following declaration.

  1. I do not have any criminal charge pending before the courts.
  1. I do not have any criminal convictions or findings of guilt for sexual offences, offences related to children, acts of violence or narcotics.
  1. I have not had any disciplinary proceedings brought against me by an employer, sporting organisation or similar body involving child abuse, sexual misconduct or harassment, other forms of harassment or acts of violence or narcotics.
  1. I am not currently serving a sanction for an anti-doping rule violation under an Australian Sports Anti-Doping Authority (ASADA) approved anti-doping policy applicable to me.
  1. I will not participate in, facilitate or encourage any practice prohibited by the World Anti-Doping Agency Code or any other ASADA approved anti-doping policy applicable to me.
  1. To my knowledge, there is no other matter that Softball Australia may consider to constitute a risk to its members, employees, volunteers, athletes or reputation by engaging me.
  1. I will notify the CEO of Softball Australia immediately upon becoming aware that any matter set out above has changed.
  1. I am a registered financial member of softball [insert state] and agree that Softball Australia or myMemberStatecanrequesta PoliceCheckfrom theFederal/State policeinaccordancewithSoftballAustralia'sMemberProtectionPolicy

______

Applicant’s signatureDate declaration made

(To be completedby theApplicant's Member State)

Softballverifies that theapplicant's qualifications setout inthis Applicationfor Position

are correct. (State)

Date:

Signature of official:

Position:

Technical Projector CoordinatorChief Statistician

Brooke WilkinsNgaire Houston