Triathlon WA School Visit Expression of Interest Form

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* 1. Please enter the contact details of your school

School Name

Teacher Name

School Address

Email Contact

Phone Contact

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* 2. What Type of School Visit are you interested in?

Assembly/Class Presentation (5-30 minutes)

Interactive Class Clinic (30-60 minutes)

Multiple Week Program

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* 3. Do you have access to a pool?

Yes

No

If No, would you be interested in delivering a Duathlon (Run/Ride/Run) format?

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* 4. Please select which day and time suit you best

	AM	PM
Monday	Monday AM	Monday PM
Tuesday	Tuesday AM	Tuesday PM
Wednesday	Wednesday AM	Wednesday PM
Thursday	Thursday AM	Thursday PM
Friday	Friday AM	Friday PM

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* 5. Do you have any specific requests for your presenter to mention?

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* 6. Does Your School Allow Newsletter Submissions?

Yes

No

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* 7. If yes, please add details who cost and who to contact for Newsletter submission.