ISA Athlete International Competition Entry Fee Claim Form

Ice Skating Australia Incorporated

Affiliated to the International Skating Union
Athlete International Competition Entry Fee Claim Form
This Application Form Contains 3 Sections:

Section 1 - Applicant Details and Bank Details

Section 2 - Claim Section
- (PART A) Itemised Details and Reason for Expenditure
Section 3 - Applicant Acknowledgement

Please Ensure all relevant sections are completed.

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.

Section 1 - Applicant Details
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
State Association*
Please provide your BSB and Account number of the account that you prefer payment from ISA to be made to.
Name on Account*

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

Section 3 - Applicant Acknowledgement
I certify that I have incurred the above expenditure on behalf of Ice Skating Australia Inc and that the total amount claimed is due and payable to me.
Applicant Agreement*

Agree
Signature of Applicant*
Date*

MonthDayYear
Should be Empty:

Ice Skating Australia Incorporated