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Application Form


Personal Details

First Name:
Last Name:

Date of Birth:

Address:
Suburb:
Postcode:

Email:
Contact Number:

Your Sport Referee

Sport Referee Name (State or National level Coach or High Performance Manager):
Referee Job Title:
Referee Email Adress:
Referee Phone Number:

Sporting Results

List your best 3 National sporting results. (Specify age/weight division).
1:
2:
3:

List your best 3 International sporting results. (Specify age/weight division).
1:
2:
3:

Why should you be considered for this grant (see Eligibility and Requirements)?

Please attach a sporting resume (maximum of One A4 page)

Please ensure the attchments are combined into ONE FILE, no bigger than 1MB and is in one of the following file formats: pdf, doc, docx, txt