Queensland Junior Track State Team 2020 - Athlete EOI

2020 Queensland Junior Track Team Athlete Expression of Interest

Event Name: 2020 Cycling Australia Junior Track National Championships

Dates: Wednesday, 18 March – Sunday, 22 March 2020

Location: Brisbane, QLD

Cycling Queensland (CQ) proposes to select a QLD State Team of athletes to participate in the above National Championships. To be considered for selection, riders are to complete this Expression of Interest. Riders who do not express interest may be passed over in the selection process in favour of riders who have expressed interest.

Before submitting the expression of interest, athletes are encouraged to read and understand the below:

To be considered for selection, Riders must:

Race as a J15 or J17 athlete.
Hold a current Race Membership License issued by Cycling Australia (CA) and be a member of a club affiliated to CQ.
Not have competed in another countries National Championships in the same season.
Have submitted an Athlete Expression of Interest for the team.
Not be serving a racing license suspension of any kind.
Abide by all Technical Regulations, By-Laws, and policies including Code of Conduct, Anti-Doping, Ergogenic Aids and Member Protection Policies of CQ and CA.
Have a clear understanding of CQ Anti-Doping & Supplement Policy, CA Member Protection Policy, CA Child Safe Policy and CQ Code of Conduct.

* Please note any athlete selected for a position within a QLD State Team will be required to complete and/or sign all of the following and submit/provide details to CQ:

ASADA Anti-Doping E-Learning Course
Athlete Agreement - Available upon selection in to the 2020 Junior Track Queensland Team
CQ Financial Responsibility Agreement

Please note: Submission of this form does not guarantee selection into the 2020 Queensland Junior Track State Team. CQ will contact all athletes who have expressed interest regarding their selection/non-selection.

Athlete Expression of Interest for the 2020 QLD Junior Track State Team close 10:00am Tuesday, 21 January 2020.

Athletes will be notified of their selection after Wednesday, 29 January 2020, date subject to change.

Question Title

* 1. Please provide Athlete EOI Details:

First Name

Surname

Gender

Date of Birth

Age

Suburb/Post Code

Club Name

CA Licence Number

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* 2. Please list the preferred contact details for all State Team communication:

First Name

Surname

Email Address

Mobile Number

Relationship to Athlete (Parent/Guardian/etc.)

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* 3. Please list any additional preferred contact person/details for all State Team communication:

First Name

Surname

Email Address

Mobile Number

Relationship to Athlete (Parent/Guardian/etc.)

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* 4. I can confirm that the Emergency Contact name and phone number listed on my membership is current?

Yes

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* 5. Please provide your medical details below:

Medicare Number

Medicare Expiry Date

Do you have Private Health Insurance (Yes/No)?

Private Health Insurance Provider

Private Health Insurance Member Number

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* 6. Please list any medical information/allergies/illnesses that you feel we should be made aware of:

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* 7. Please outline results/skills/experience/background that help support your Expression of Interest:

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* 8. Have you completed an ASADA Level 1 Certificate in 2020?
Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.

Yes

Queensland Junior Track State Team 2020 - Athlete EOI

Question Title

* 1. Please provide Athlete EOI Details:

Question Title

* 2. Please list the preferred contact details for all State Team communication:

Question Title

* 3. Please list any additional preferred contact person/details for all State Team communication:

Question Title

* 4. I can confirm that the Emergency Contact name and phone number listed on my membership is current?

Question Title

* 5. Please provide your medical details below:

Question Title

* 6. Please list any medical information/allergies/illnesses that you feel we should be made aware of:

Question Title

* 7. Please outline results/skills/experience/background that help support your Expression of Interest:

Question Title

* 8. Have you completed an ASADA Level 1 Certificate in 2020?Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.

* 8. Have you completed an ASADA Level 1 Certificate in 2020?
Please note: If you have already completed Level 1, you will need to complete the Level 2 ASADA Certificate.