www.translpantteamireland.wordpress.com Expression of interest - World Transplant Games 2019 Question Title * 1. Please fill in your details below: Name: Address 1: Address 2: City/Town: County Mobile Number: Email Address: Age: Question Title * 2. Please indicate your type of transplant Kidney Liver Heart Lung Pancreas Bone Marrow Kidney / Pancreas Kidney / Liver Heart / Lung Heart / Kidney Other (transplant) *please specify* Question Title * 3. Please indicate your year of transplant: 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 Question Title * 4. Please indicate the sports in which you have previous experience: Athletics (track - middle & long distance) Athletics (track - sprints) Athletics (field - throwing events) Athletics (field - jumping events) Badminton Cycling Darts Golf Petanque (French Boules) Road Running Squash Swimming Table Tennis Tennis Ten Pin Bowling Archery Question Title * 5. Please indicate the sports in which you have little or no experience but would like to try: Athletics (track - middle & long distance) Athletics (track - sprints) Athletics (field - throwing events) Athletics (field - jumping events) Badminton Cycling Darts Golf Petanque (French Boules) Road Running Squash Swimming Table Tennis Tennis Ten Pin Bowling Question Title * 6. Have you competed in any transplant/dialysis Games before? 2018 - European Transplant & Dialysis Games Sardinia 2017 - World Transplant Games - Spain 2016 - European Transplant & Dialysis Games Finland 2015 - World Transplant Games - Argentina 2014 - European Transplant & Dialysis Games Poland 2013 - World Transplant Games - South Africa 2012 - European Transplant & Dialysis Games Croatia 2011 - World Transplant Games Sweden 2010 - European Transplant & Dialysis Games Ireland 2009 - World Transplant Games Australia 2008 - European Transplant & Dialysis Games Germany 2007 - World Transplant Games Thailand 2006 - European Transplant & Dialysis Games Hungary 2005 - World Transplant Games Canada I have other competition experience (Please specify below) I do not have competition experience Other competition experience (please specify) Question Title * 7. I would like to be added to a mailing list for an online Newsletter that will be specifically used to keep people up to date on plans for WTG2019 on the understanding that I will be offered the opportunity to unsubscribe at any time. Yes No Done