ISA Funding and Incentive Claim Form (Synchronized)

Ice Skating Australia Incorporated

Affiliated to the International Skating Union
Funding and Incentive Claim Form

(Synchronized)
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 athlete.development@isa.org.au

Section 1 - Applicant Details
Applicant Name*

First NameLast Name
Team Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Contact Number*
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 2 - Event and Results

Please refer to policy ISA-04 Funding and Incentive Policy available on the ISA website www.isa.org.au
PLEASE ONLY SELECT THE RELEVANT BOXES AND CLAIMS
Section 2a - Claims for Finishing Top 15
- ISU World Synchronized Skating Championships
- ISU World Junior Synchronized Skating Championships
Championship Event 1
Amount (2a)
Section 2b - Claims for Qualifying Top 20
- ISU World Synchronized Skating Championships
  ISU World Junior Synchronized Skating Championships
Championship Event 1
Amount (2b)
Section 2c - World Junior Challenge Cup
Compete at World Junior Challenge Cup
Amount (2c)

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*

MonthDayYear
Enter the message as it's shown*
Should be Empty:

Ice Skating Australia Incorporated