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:*

Sweep and Coxswain Options
Nominating for:*
Prefered Sweep Side*

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.
I with to be considered to cox the :

Men's EightWomen's Eight
Please include your current weight*
kg

Collapse Stopper
In submitting this nomination I declare I have read and understand the Rowing ACT Selection Policy and the 2015 AMRC Team Event Requirements. In addition I declare I have read and understand the Rowing Australia Member Protection Policy and agree to uphold the principles contained therein.*

I agree
Should be Empty: