Limerick Performance Centre Application Form

Please complete the following application form to apply for a place at the Limerick Performance Centre 2013/2014

Name of Applicant:

This is a required question

Date of Birth:

Please tick below which type of membership you wish to apply for:

This is a required question

Are you currently a member of the Limerick Performance Centre?

This is a required question

Have you paid for membership to the programme for this season?

This is a required question

If you are applying for the Limerick Performance Centre Trainability Squad please indicate which training sessions you will be availing of:

Saturday PM and Wednesday AM are now full (updated September 20th @ 09:00am)

This is a required question

Contact Email Address:

If applicant is under 18 please include parent/guardian email address

This is a required question

Home Address

This is a required question

Club Information

Current Club:

This is a required question

Club Coach Name

This is a required question

Club Coach Email Address

This is a required question

Main Event:

This is a required question

Personal Best Time for this Event(s):

This is a required question

Have you qualified for the National Squads Programme for the coming season?

This is a required question

Please indicate the level of education/employment in which you will be commencing from September 1st 2013

This is a required question