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This form is an Expression of Interest for athletes to take part in the 2014 AER Australian Championships, Brisbane Australia on 17-21st September 2014. Please read and complete each question carefully, making sure all information is accurate. Thank you

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* 1. Name of person completing this form, (If Athlete is under 18 years of age).

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* 2. Please indicate which level you are trialling for

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* 3. FULL LEGAL NAME - This must be the name that appears on the athletes passport

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* 4. Preferred Name - If different from above

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* 5. Physical Address

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* 6. Email Address - If athlete is under 18 years of age, please use a parent or guardian's email. This will be used for official communication regarding the tour, including booking flights, accomodation and invoicing.

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* 7. Mobile Phone Number

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* 8. Home Phone Number - Please include area code

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* 9. Work Phone Numer - Please include area code

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* 10. NZ Passport Number - (Please note this is an FIG event and you must hold a NZ Passport).

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* 11. NZ Passport Expiry Date

Date

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* 12. Non NZ Passport Expiry Date

Date

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* 13. Date of Birth

Date

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* 14. Club Name

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* 15. Coach's Name

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* 16. Coach's email address

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* 17. Do you have the required GSNZ uniform (Black adidas tracksuit, GSNZ tshirt)? If not what items do you require?

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* 18. Consent - By ticking this box you are agreeing to GymSports New Zealand Terms and Conditions.

You are also acknowledging that all information you have provided is correct, that you wish to trial for the event and will pay the trial registration fee of $50.

This is a self funded tour and the estimated cost is $2500 per person (not incl. unifrom).

Please see the overseas Tour Policy for further information.

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* 19. Today's Date

Date
If you have any further questions please email Katie Dee (Vulinovich) on overseas.tours@gymsportsnz.com

Trial Registration Fee - $50 non-refundable trial fee. No Expression of Interest forms will accepted without payment.

Bank Name: The National Bank
Account Number: 06-0582-0129292-00
Account Holder's Name: Gymsports New Zealand
Reference: Your Name, AussyNats, AER

If you have any further questions please email Katie Dee on overseas.tours@gymsportsnz.com

Thank you for completing this form and good luck at the trial.

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