Name

Address:

E-mail Address:

Telephone Numbers (h) (m)

Sport: Club

School (if applicable):

Best Four Performances (list)

1.

Australia

Records (list)

1.

Ambition:

A sentence that best describes you:

Hobbies:

Your Favourite

1. Food -

   ---

2. Drink -

3. ---

4. Fruit -

5. ---

6. Car -

7. ---

8. Song -

9. ---

10. Film -

11. ---

12. T.V. Program -

13. ---

14. Sportsman -

15. ---

16. Sportswoman -

17. ---

18. Team -

19. ---

20. Restaurant -

21. ---

22. Jogger Brand -

23. ---

Future Sports Program

Agreement

You agree to the use of your photograph and details for publicity /promotional purposes and may be required to have your photograph taken with sponsors for publicity purposes.

Signed/Name Date: