QLD State Team Official Nomination Form

Nomination Form for

Relief Coaches

First Name*

Surname*

Year of Birth*

Contact Email*

Contact Phone Number*

GA ID Number (if known)

Current Coaching Accreditations (please select all options that apply)*

	MAG	WAG	RG	TRP	ACR	AER	GfA	KG
Intermediate
Advanced or higher

Location*

Street Address

Street Address Line 2

Suburb

Postal Code

Distance willing to travel*

Any other Information

Use and Disclosure of Personal Information*

I understand that by completing this form, I agree to my personal details being utilised on a state relief databaseI understand that by being on a relief database, club personnel may contact me directly via the contact details providedI understand that should I wish to remove myself from the database, this will only be done upon written consent to Gymnastics QLD

Thank you for completing the GQ Nomination Form for Relief Coaches. Please review the above information, to ensure that all your details are correct.

By signing below, I agree with the use and disclosure of my personal information as indicated above.

Signature - Use Mouse*

Date of Signing*

DayMonthYear

To complete your nomination and send off to GQ, please click the Submit button below