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*

Other Club Option
Please Specify Club:*

Other Club Option Collapse
Nominating as:*

General Rower Options
Nominating for:*

Interstate EightInterstate Youth EightInterstate Lightweight Quad (Women Only)Interstate Lightweight Four (Men Only)Interstate Single Scull

Lightweight Options
Please include your current weight*
kg

Sweep Options
Prefered Sweep Side*

Stroke sideBow side

Coxswain Options
I with to be considered to cox the :*

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

Coach Options
I with to be considered to coach the :*

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

Collapse Stopper
In submitting this nomination I declare I have read the Rowing ACT Selection Policy, and the Rowing Australia Member Protection Policy, and agree to uphold the principles contained therein.*

I agree
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