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AUSTRALIAN LITTLE ATHLETICS CHAMPIONSHIPS 20th - 24th April 2017 Sydney Olympic Park Athletics Centre New South Wales NOMINATION FORM Under 13 and Under 15 athletes, this is your opportunity to represent the ACT at the National level. Please complete and return this form to the ACT Little Athletics Office PO Box 5094 Garran ACT 2605 or [email protected] by Monday 6th March 2017. Please mark clearly on the envelope or in the email subject “Nomination Form – “Sydney”. Please make sure you read the accompanying information sheet prior to nominating! ATHLETE’S NAME: ………………………………………………………………… AGE GROUP: Circle one U13 U15 Circle one MALE FEMALE DOB ……../……../………… REGISTRATION NO: …………….. CENTRE: ……………………………... ATHLETE’S ADDRESS: …………………………………………………………... ………………………………………………………………………………………….. PARENT’S NAME & PHONE NUMBER/S: …………………………………….. ………………………………………………………………………………………… PARENT’S EMAIL ADDRESS: …………………………………………………... Circle one DO YOU HAVE YOUR OWN COACH: YES NO If so, Coach’s name: ………………………………………………………………... Coach’s contact details: Phone:………………Email:…………………………… Centre President Endorsement Signature:……………………………………. Please note: There is a levy for selected athletes and the cost will be approximately $1,100 $1,300. This cost will cover all costs involved: transport, accommodation, uniform, food, entertainment and sightseeing for 5 days. The ACT ALAC Team will be published on the LAACT website on Wednesday 22nd March at 2.00pm. All selected athletes are required to attend team training sessions during the 4 weeks prior to the championships. A compulsory team meeting for selected athletes and parents will be on Thursday 24th March 2016 6.30pm at the Southern Cross Club Woden. An invoice will be issued to each family at the meeting and a non-refundable $400.00 deposit must be paid before or on Tuesday 28th March 2016. SIGNATURE OF ATHLETE:…………………………………………Date:……….. NAME OF PARENT/GUARDIAN: ………………………………………………….. SIGNATURE OF PARENT/GUARDIAN: ………………………….Date:………..