in full (e.g. Matthew)

If you are a nominating Coxswain, please select N/A

Please choose your most preferred side to row on (Scullers select N/A). If you are a nominating Coxswain, please select N/A.

DD/MM/YYYY

e.g. 1 Smith Street

Please add spacing (e.g. 0412 345 678)

Please add spacing (e.g. 0412 345 678)

Please add spacing (e.g. 0412 345 678)

Please outline any challenges you would face if required to relocate. PLEASE NOTE: If successful in gaining selection, it is expected that crews would prepare in the same location. Anything contrary to this would be considered on a case-by-case basis.

(e.g. M1234567) If you do not have a valid passport, please write "To Obtain". PLEASE NOTE: If invited to attend Selection Trials, you MUST have a valid Australian passport and be able to present this prior to your participation.

DD/MM/YYYY (If you do not have a valid passport, please write "To Obtain")

In full (e.g. Sydney University Boat Club)

I agree to complete the Clean Sport 101 and Level 1 Anti-Doping online modules no later than 21 March, 2021. (https://elearning.sportintegrity.gov.au/index.php) PLEASE NOTE: If selected, you may be required to complete further online educative programs.

I acknowledge and agree that:                                                                                                                                                                  1. I have access to and will be bound by and observe the terms and conditions of the RA Policies (available at http://www.rowingaustralia.com.au/rowing-australia-policies/ and https://www.rowingaustralia.com.au/national-team-selection-information/) including, without limitation, the RA National Selection Policy and the RA Event Requirements (also available at http://www.rowingaustralia.com.au/national-team-selection-information/);                                                                                                                                                                                               2. the RA Policies may be amended from time to time. I will observe those policies as amended, and I acknowledge that any amendments to those policies will apply following notification on the RA Website (https://www.rowingaustralia.com.au/) or notification via email.

I acknowledge and agree that:                                                                                                                                                                  1. I have read, fully understand and will be bound by and observe the terms and conditions of the RA Participant Agreement (available at https://rowingaustralia.com.au/wp-content/uploads/2020/07/RA-Participant-Agreement-2021-online-nomination-underage.pdf), including the ART Code of Conduct and Behaviour attached thereto, and that the references to “the Participant” in that agreement are references to me as the participant the subject of this form;                                                                                                                                                                                                              2. the terms and conditions contained in the RA Participant Agreement commence on the date of submission of this Nomination Form or on the date I first compete at an RA event in the 2020/2021 season (whichever is the earlier) and continue until 31 December, 2021 (unless superseded and replaced by another RA participant agreement or terminated in accordance with its terms);                                                                                                                                                                                                           3. I will, for the purposes of the RA Participant Agreement, fully disclose the details of any existing Commercial Arrangements to which I am a party including any sponsorship endorsement by email to emcorist@rowingaustralia.com.au by no later than 5:00pm on 10 April, 2021;                                                                                                                                                                              4. I will, for the purposes of the RA Participant Agreement, fully disclose the details of any existing Athlete Agreement to which I am a party by email to nwagstaff@rowingaustralia.com.au by no later than: In the case of Participants nominating for the Under 23 Team: 5:00pm on Friday 11 September, 2020; in the case of Participants nominating for the Under 21 Team: 5:00pm on Monday 15 February, 2021; in the case of Participants nominating for the Junior Team: 5:00pm on Friday 12 March, 2021.

I am the Participant’s parent and/or legal guardian. I:                                                                                                                               1. acknowledge and agree that I have read and explained the contents of this Nomination Form and the RA Participant Agreement to the Participant;                                                                                                                                                                       2. consent to the Participant being subject to the terms and conditions in this Nomination Form and the RA Participant Agreement;                                                                                                                                                                                                      3. declare that the statements made in this Nomination Form are to the best of my knowledge and belief true and correct.