NOrth wales Gold Card

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Full name

Full Address

Date of Birth

Telephone number

Email address

Club Name

In what sport have you gained honours?

How long have you been participating in your sport?

If you answered Yes, please state which squad

Achievements

Achievement Date - 1 Achievement Venue - 1 Achievement Event - 1 Achievement - 1

Achievement Date - 2 Achievement Venue - 2 Achievement Event - 2 Achievement - 2

Championships

Championship Event - 1 Championship Venue - 1 Championship Date - 1 Championship Ranking - 1

Championship Event - 2 Championship Venue - 2 Championship Date - 2 Championship Ranking - 2

Checklist and Signature

Squad invitation letter of supporting evidence of achievements

One recent passport photo of yourself

Training program signed by your national governing body

The information provided in this form is true and accurate to the best of my knowledge. I agree to abide by all of the conditions set out in this application pack.

Athlete Signature