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This form is an Expression of Interest for athletes to take part in the Trampoline World Age Group Championships on 14-16 November 2014, Daytona Beach, USA. 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 discpline you are trialling for

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* 3. Please Indicate which level you are trialling for

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

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* 5. Preferred Name - If different from above

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* 6. Physical Address

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* 7. 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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* 8. Mobile Phone Number

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* 9. Home Phone Number - Please include area code

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* 10. Work Phone Numer - Please include area code

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* 11. NZ Passport Number - (Please note if you are trialling for an FIG you must hold a NZ Passport).

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* 12. 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. Coaches email

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* 16. Coach's Name

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* 17. Do you have the GSNZ particpation uniform (black Adidas tracksuit, purple/grey leotards). If not what do you require and sizes

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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 trail registration fee of $50.

The event is self funded and will cost approximately $6000

If you have a parent wishing to travel as a chaperone please get them to complete the officials EOI. Chaperones can only be considered if they have submitted an EOI by the due date.

Please see the overseas Tour Policy for further information.

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* 19. Today's Date

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

Please pay:
Bank Name: The National Bank
Account Number: 06-0582-0129292-00
Account Holder's Name: Gymsports New Zealand
Reference: Athletes Name, WORLDAGE, TRA

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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