RACT Nomination Form

2015 MASTERS STATE TEAM

Rower and Coxswain Nomination Form

This form is available until 5pm 13th February 2015. No late nominations will be accepted.
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*
Nominating as:*
- Nominating for:*
- Stroke sideBow side
- Please include your trial pair partners name. This may be completed at a later date. However, please ensure you partner completes this nomination form as this is required regardless of whether you include your partner or not. As per the event requirements final combinations must be received no later than 10pm Wednesday 26th February 2014.
- Men's EightWomen's Eight
- Please include your current weight*
  kg
- I agree
- Should be Empty: