Expression of Interest

Please complete this expression of interest form if you wish to be considered for selection into a Bay of Plenty or Coromandel Representative Team for the 2019 New Zealand Representative Challenge.

The 2019 2019 New Zealand Representative Challenge Bay of Plenty and Coromandel Selection Policy can be found on the SLSNZ Website here.

Please contact Scott Bicknell - Interim Sport Manager Eastern Region at scott.bicknell@surflifesaving.org.nz or 027 327 7339 if you have any queries.

Question Title

* 1. Name

Question Title

* 2. Email

Question Title

* 3. Contact Number

Question Title

* 4. Which Representative Team do you wish to be selected for:

Question Title

* 5. Primary Coromandel Club Membership (If Applicable)

Question Title

* 6. Primary Bay of Plenty Club Membership (If Applicable)

Please answer the following questions if you are not a current member of a Bay of Plenty or Coromandel club and still wish to be considered for selection into a Representative Team.

Question Title

* 7. Do you wish to be considered for selection as a drafted athlete:

Question Title

* 8. Do you have any special ties to a Coromandel or Bay of Plenty club?

Question Title

* 9. Competing in the 2019 Representative Challenge as a member of the Bay of Plenty or Coromandel Representative Team is done on a user-pays basis.

T