WRAS 2018 Cycling Squad Nomination Form
Cyclist's personal details
First name
Your answer
Surname
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
Are you of Aboriginal or Torres Strait Islander decent?
(For statistical purposes could you please answer)
Do you have a disability?
(For statistical purposes could you please answer)
Address
Your answer
Town
Your answer
Postcode
Your answer
Mobile number
Your answer
Email
All future correspondence about your cycling squad nomination will be sent to the email address you provide
Your answer
School attending (or workplace if no longer attending school)
Your answer
Current school year
Your answer
Cycling club
Your answer
Cycling Australia licence number
Your answer
Mother/Guardian's name
Your answer
Mobile
Your answer
Father/Guardian's name
Your answer
Mobile
Your answer
Medical information
Do you have any recurring sports injury, medical condition, or allergies that we need to be aware of?
If 'Yes' please specify
Your answer
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