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This form is an Expression of Interest for officials to take part in the 2014 WAG levels tour, Singapore on 6-9th November 2014. Please read and complete each question carefully, making sure all information is accurate. Team Manager and coaches will receive some funding towards their costs (TBC depending on number of athletes). Chaperones are self funded. Thank you

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* 1. Position on Tour

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

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* 3. Preferred Name - If different from above

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* 4. Physical Address

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* 5. Email Address

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* 6. Mobile Phone Number

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* 7. Home Phone Number - Please include area code

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* 8. Work Phone Numer - Please include area code

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* 9. NZ Passport Number

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* 10. NZ Passport Expiry Date

Date

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* 11. If you have don't hold a NZ Passport, please add the name of the country you hold a passport for, along with the passport number.

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* 12. Non NZ Passport Expiry Date

Date

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* 13. Club Name

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* 14. Previous tour experiences

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

Please see the overseas Tour Policy for further information.

If you have any further questions, please contact Katie Vulinovich on katie.vulinovich@gymsportsnz.com

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* 16. Today's Date

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