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:*
- Interstate EightInterstate Youth EightInterstate Lightweight Quad (Women Only)Interstate Lightweight Four (Men Only)Interstate Single Scull
- Please include your current weight*
  kg
- Stroke sideBow side
- Men's EightWomen's EightMen's Youth EightWomen's Youth Eight
- Please include your current weight*
  kg
- Men's EightWomen's EightMen's Youth EightWomen's Youth EightMen's Lightweight FourWomen's Lightweight Quad
- 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
- I agree
- Should be Empty: