Antrim Declaration Form

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Please ensure all details are correct

Do you consent to being contacted in relation to the information you have provided for the purposes of representing Ireland by the Athletics Ireland High Performance Team. Your information will be held for one year for the purposes as given. This database will then be destroyed as per our GDPR policy.

Yes

Clear selection

Full Name as per Passport *

Mobile number

Email *

Club *

Coach Name *

Coaches Email

Gender *

Female

Male

Date of Birth *

YYYY

Are you currently eligible to represent Ireland under IAAF rules? *

Yes

Other:

Half marathon best since 1st Jan 2019?

Venue and date of performance above?

Half marathon pb?

Venue and approximate date of Pb?

Any other significant performances or information relevant to selection including: performances distances from 5km upwards.

Submit

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