ISA Funding and Incentive Claim Form (Singles, Pairs, Ice Dance)

Ice Skating Australia Incorporated

Affiliated to the International Skating Union
Funding and Incentive Claim Form

(Singles, Pairs, Ice Dance)
This Application Form Contains 3 Sections:

Section 1 - Applicant Details and Bank Details

Section 2 - Events and Results

Section 3 - Applicant Acknowledgement

Please Ensure all relevant sections are completed.

For more information refer to ISA Policy available on the ISA website.

Note: Claims could take betwen 6 - 8 weeks to be processed and paid. If you choose to use an overseas bank account processing time may vary and transaction and exchange charges may apply.

If you do have any questions do feel free to contact us at high.performance@isa.org.au

Section 1 - Applicant Details
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Contact Number *
State Association *
Membership No.
Please provide your BSB and Account number of the account that you prefer payment from ISA to be made to.
Name on Account *

First Name Last Name
Bank *
Branch *
BSB *
Account Number *

Section 3 - Applicant Acknowledgement
I confirm that I have read, understood the ISA-04 Funding and Incentive Policy and i declare that all information provided is true and correct.

Please note that any incorrect claims will not be processed and athlete will receive no funding.
Total Amount Claimed
Applicant Agreement *

Agree
Signature of Applicant *
Date *

Month Day Year
Should be Empty:

Ice Skating Australia Incorporated