APPLICATION FOR ENTRY (Please read the schedule thoroughly before filling in this entry form and signing the acknowledgement below)

Size: px
Start display at page:

Download "APPLICATION FOR ENTRY (Please read the schedule thoroughly before filling in this entry form and signing the acknowledgement below)"

Transcription

1 Royal Agricultural Society of WA WOOD CHOPPING APPLICATION FOR ENTRY (Please read the schedule thoroughly before filling in this entry form and signing the acknowledgement below) Entries close 5.00pm FRIDAY 30 JUNE ENTRIES RECEIVED AFTER THIS TIME AND DATE WILL NOT BE ACCEPTED. Exhibitors are requested to forward their entry forms to: Wood Chopping Coordinator, PO Box 135, Claremont WA 6910 PERSONAL DETAILS Exhibitor Name: (This will be printed in the Catalogue and Prize Certificates) Contact Name: Mr, Mrs, Ms, Miss... First Name: Surname: Postal Address: Suburb: State: Postcode: Telephone:...Fax:... Mobile: PAYMENT OF ENTRY FEES Method of Payment for Entry fees: Cheque for $... to be made payable to the Royal Agricultural Society of WA. (Office use only - cheque number ) Please debit my Mastercard Visa for the amount of $... Card Number: / / / Expiry Date: / Name on Card:...Signature... CONDITIONS OF ENTRY 1. I/We certify that the particulars as shown on this entry form are correct and I have read and agreed to the terms and conditions of entry as detailed in the 2017 Wood Chopping Schedule, including the liability and indemnity provisions. 2. I/We agree to be bound by the Society s General Show Regulations (refer to the RASWA website or alternatively a copy is available upon request). 3. Permission is hereby granted to the publication of photographs relating to participation in the Competition. SIGNATURE OF EXHIBITOR:... DATE: / / PRIVACY ACT STATEMENT The information provided by the Exhibitor in the application for entry is collected and used by the Royal Agricultural Society of Western Australia (RASWA) to organise and conduct Competitions at the 2017 IGA Perth Royal Show. We may publish details such as your name, address and exhibit details in any RASWA publication or communication. Such information may also be made available to, and published by, the media. We will not disclose your information without your consent for any other purpose unless required or authorised by law. You may request access to your personal information and, if necessary, request that our records of that information be corrected by writing to the Chief Executive Officer at the Royal Agricultural Society of Western Australia, PO Box 135, Claremont WA PAGE 1 OF 5

2 ACCOUNT DETAILS RASWA has a policy whereby all prize money is paid by EFT (Electronic Funds Transfer). Your banking details will be kept secure and can only be used by RASWA to credit your bank account. Please complete your account details even if you have provided them previously. In accordance with the rules of the competition, failure to provide your bank details will mean that any prize money you earn will be forfeited and retained by RASWA. Please complete the following: Account Name. Print clearly the account name as shown on your account records. Do not write the account type (for example savings, cheque or mortgage offset). Include spaces between each word and between initials in the account name. Bank. This is the bank name (for example NAB, ANZ, Commonwealth Bank, etc). BSB No. This six digit number identifies the financial institution. Do not include spaces, dashes or hyphens in the number. Account No. You cannot use an account number with more than nine characters. Do not include spaces in the account number. Prize money cannot be paid via electronic funds transfer (EFT) if the nominated account has restrictions on EFT deposits, is a credit card, or an overseas account. THIS SECTION MUST BE COMPLETED. ACCOUNT NAME: Royal Agricultural Society of WA PRIZE MONEY PAYMENT DETAILS BANK: BSB NO: ACCOUNT NO: GST MANAGEMENT RASWA requires the following information from all Competitors in order to make appropriate payments to those Competitors who win a prize. 1. Is what you are supplying to RASWA done as a private recreational pursuit or hobby? Y N 2. If No to Question 1, what is your ABN? 3. Are you registered for GST? Y N NOTE: It is a condition of entry that this information be forwarded to the Royal Agricultural Society of WA. If you do not complete this section of the form we may be required to withhold 46.5% of your prize payment. Office Use Only Account Details Entered: Date: / / Please tick Please tick

3 Royal Agricultural Society of WA WOOD CHOPPING P Class No. Event $ SINGLET SIZE: 1 300mm TREE PEGGING WORLD CHAMPIONSHIP mm AUSTRALIAN TREE PEGGING CHAMPIONSHIP mm AUSTRALIAN CHAMPIONSHIP S/B mm AUSTRALIAN CHAMPIONSHIP U/H mm S/B CHAMPIONSHIP mm U/H CHAMPIONSHIP mm WESTERN AUSTRALIAN CHAMPIONSHIP U/H (WA ONLY) mm WESTERN AUSTRALIAN S/B CHAMPIONSHIP (WA ONLY) mm U/H mm OPEN HANDICAP U/H mm OPEN HANDICAP U/H mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm U/H AND S/B COMBINATION mm 3RD DIVISION S/B mm 1ST DIVISION U/H mm 2ND DIVISION U/H mm TREE PEGGING mm TREE PEGGING mm TREE PEGGING mm S/B mm S/B mm S/B mm S/B mm 1ST DIVISION S/B mm 3RD DIVISION S/B mm 1ST DIVISION S/B mm 2ND DIVISON S/B mm 1ST DIVISION S/B mm 2ND DIVISION S/B mm 1ST DIVISION S/B HARD HITTING mm 2ND DIVISION U/H mm U/H 250mm S/B PAIRS EVENT FOUR MAN RELAY, 1 X 275mm U/H, 1 X 250mm S/B AND 1 X 2 MAN BUTCHERS BLOCK mm S/B - NOVICE mm U/H - NOVICE mm U/H - NOVICE mm JUNIOR U/H ROUND ROBIN (Under 18 years) mm JUNIOR U/H ROUND ROBIN (Under 16 years) mm VETERANS S/B (55 years and over) mm VETERANS S/B (55 years and over) mm VETERANS S/B ROUND ROBIN (65 years and over) mm D/H SAWING CHAMPIONSHIP (Open to all sawyer and type of saws) mm D/H SAWING HANDICAP mm S/H SAWING CHAMPIONSHIP (Open to all sawyer and type of saws) mm S/H SAWING HANDICAP (Open to all sawyer and type of saws) mm U/H, 250mm S/B, FATHER AND SON WA VERSUS VETERANS. BEST OF 3 SERIES WA VERSUS NZ. BEST OF 3 SERIES Tick in box below for size required. Right OR Left Handed R L (Please tick) (Transfer this amount to the payment of entry fees on front page) $ 14 (90cm) 16 (95cm) 18 (100cm) 20 (105cm) 22 (110cm) 24 (115cm) 26 (120cm) 28 (125cm) PAGE 3 OF 5

4 Royal Agricultural Society of Western Australia 2017 IGA PERTH ROYAL SHOW - WOOD CHOPPING DISCLAIMER STATEMENT Before signing this Disclaimer, refer to the Section Conditions and General Regulation 17 in the Society s Wood Chopping Schedule ALL ADULT COMPETITORS/PARTICIPANTS 18 YEARS OF AGE and OVER I acknowledge and agree as a condition of participating at the 2017 IGA Perth Royal Show that neither the Royal Agricultural Society of Western Australia, its directors, officers, employees, members and agents, participants, officials, volunteers, medical personnel, any persons, promoters, sponsors, providers of equipment, advertisers, nor owners or lessees of premises used to conduct the EVENT(S) shall be under any liability whatsoever for either the death of or for any injury, loss or damage which may be sustained or any claim, demand, suit or costs arising there from and incurred by myself or any attendant or any other competitor/participant for whom I am responsible, as a result of participation in or being present at the EVENT(S). I acknowledge that wood chopping activities are dangerous and that accidents causing death, injury, disability and property damage, can, and do occur. I unconditionally accept responsibility to safeguard myself and any attendant and any other competitor/ participant for whom I am responsible. By signing hereunder I confirm I have read and understood the contents of this Disclaimer together with the Society s Section Conditions and General Show Regulation 17, by which I agree to abide. Name (Print): Signature: Dated this: day of 2017 PARENT/GUARDIAN CONSENT for COMPETITORS/PARTICIPANTS UNDER 18 YEARS OF AGE I,, being the parent/guardian of Name: Address: Date of Birth: confirm that I have read the whole of this document and have taken all necessary actions to ensure I am aware of the activity in which the above named competitor/ participant will participate at the 2017 IGA Perth Royal Show and consent to him/her participating. In doing so, I acknowledge that wood chopping activities are dangerous and that accidents causing death, injury, disability and property damage, can, and do occur. I unconditionally accept responsibility to safeguard the above named competitor/participant for whom I am responsible. I acknowledge and agree that neither the Royal Agricultural Society of Western Australia, its directors, officers, employees, members and agents, participants, officials, volunteers, medical personnel, any persons, promoters, sponsors, providers of equipment, advertisers nor owners or lessees of premises used to conduct the EVENT(S) shall be under any liability whatsoever for either the death of or for any injury, loss or damage which may be sustained or any claim, demand, suit or costs arising there from and incurred by the above named competitor/participant or by any other person for whom I am responsible as a result of participation in or being present at the EVENT(S). By signing hereunder I confirm I have read and understood the contents of this Disclaimer together with the Society s Section Conditions and General Show Regulation 17 by which I agree to abide. Name (Print): Signature: Dated this: day of 2017 PAGE 4 OF 5

5 WOOD CUTTING PERFORMANCES The undermentioned are my last six performances for each type of event. STANDING BLOCK Date Town & State Size of Log My Back Mans Name & UNDERHAND Date Town & State Size of Log My Back Mans Name & TREE FELLING PERFORMANCES Date Town & State Size of Log My Back Mans Name & PAGE 5 OF 5

Application form for an Annual Practising Certificate 2017/2018 Application form for updating Practising Status 2017/2018 (Annual Renewal)

Application form for an Annual Practising Certificate 2017/2018 Application form for updating Practising Status 2017/2018 (Annual Renewal) Application form for an Annual Practising Certificate 2017/2018 Application form for updating Practising Status 2017/2018 (Annual Renewal) Important Notification under sections 26 & 144 of the Health Practitioners

More information

Medical gap arrangements - practitioner application

Medical gap arrangements - practitioner application Medical gap arrangements - practitioner application For services provided in a licensed private hospital or day hospital facility (Private Hospital) only. Please complete this form to apply for participation

More information

WV Address WV Phone # Father / Male Guardian Information (required) Work Phone # Home Phone # Cell Phone # Home Address (if different)

WV Address WV Phone # Father / Male Guardian Information  (required) Work Phone # Home Phone # Cell Phone # Home Address (if different) 2016 Freestyle/Freeski BagJump/Trampoline Skills Training Sessions & 6 Day Camp Application For each athlete, please complete, sign and return all pages of this application and include payment in full

More information

ENROLMENT FORM. Title: First Name: Surname: Postal Address: Postcode: Emergency Contact: Relationship: Phone: What is your main fitness goal?

ENROLMENT FORM. Title: First Name: Surname: Postal Address: Postcode:   Emergency Contact: Relationship: Phone: What is your main fitness goal? ENROLMENT FORM Personal Information Title: First Name: Surname: Date of Birth: Sex: Female Male Postal Address: Postcode: Phone: Home: Work: Mobile: Email: Preferred method of contact: Letter Phone Email

More information

Application form for an Annual Practising Certificate 2018/2019 Application form for updating Practising Status 2018/2019 (Annual Renewal)

Application form for an Annual Practising Certificate 2018/2019 Application form for updating Practising Status 2018/2019 (Annual Renewal) Application form for an Annual Practising Certificate 2018/2019 Application form for updating Practising Status 2018/2019 (Annual Renewal) Important Notification under sections 26 & 144 of the Health Practitioners

More information

OPPORTUNITIES TO COLLABORATE

OPPORTUNITIES TO COLLABORATE OPPORTUNITIES TO COLLABORATE Association of Medicine & Psychiatry (AMP) 2017 Annual Meeting The Association of Medicine and Psychiatry is planning its Annual Meeting at the beautiful Hotel Allegro in Chicago,

More information

UPA Old School Iron Gym Winter Rack Attack 2017!

UPA Old School Iron Gym Winter Rack Attack 2017! UPA Old School Iron Gym Winter Rack Attack 2017! MEET DIRECTORS: TJ Slomka - osigym@yahoo.com (216) 392-0981 Luz Miller - msmillie76@gmail.com (216) 322-7264 EVENT LOCATION: ELIGIBILITY: WEIGH-IN: Title

More information

Eau Claire Tower Fitness Centre MEMBERSHIP APPLICATION

Eau Claire Tower Fitness Centre MEMBERSHIP APPLICATION Eau Claire Tower Fitness Centre MEMBERSHIP APPLICATION SHADED AREAS FOR OFFICE USE ONLY MEMBERSHIP # SECURITY CARD # START DATE DD MM YY NAME: FIRST LAST DATE DD MM YY OF BIRTH HOME ADDRESS HOME/CELL PHONE

More information

Welcome to Ballarat Pony club for the year

Welcome to Ballarat Pony club for the year Welcome to Ballarat Pony club for the year 2015-2016 Thank you for joining Ballarat Pony Club! We hope your family enjoys being part of the club and benefits from the many skills gained through participation

More information

White Plains YMCA 2016 Summer Camp Registration Form

White Plains YMCA 2016 Summer Camp Registration Form White Plains YMCA 2016 Summer Camp Registration Form Camper Information Child s First Name: Child s Last Name: Date of Birth: Gender: Age: S L XL What grade will your child be entering in the Fall of 2016?:

More information

These Rules of Membership apply in respect of all Products purchased by a Member from Sigma (and any Program Partner) on or after 1 February 2017.

These Rules of Membership apply in respect of all Products purchased by a Member from Sigma (and any Program Partner) on or after 1 February 2017. Rules of Membership 1. Introduction These Rules of Membership apply in respect of all Products purchased by a Member from Sigma (and any Program Partner) on or after 1 February 2017. The previously published

More information

Register your team now and begin fundraising to support United Way and win prizes!

Register your team now and begin fundraising to support United Way and win prizes! Register your team now and begin fundraising to support United Way and win prizes! Team Captain Registration Form IMPORTANT: Please note that your $250 team registration fee must be paid on or before Friday,

More information

TEACHER TRAINING APPLICATION

TEACHER TRAINING APPLICATION Introduction TEACHER TRAINING APPLICATION Thank you for your interest in the Hot 8 Yoga Teacher Training Program! Below you will find detailed instructions on how to apply. Please be aware that the Hot

More information

FRIDAY, SEPTEMBER 15 REGISTER YOUR TEAM NOW AND BEGIN FUNDRAISING TO SUPPORT UNITED WAY AND WIN PRIZES!

FRIDAY, SEPTEMBER 15 REGISTER YOUR TEAM NOW AND BEGIN FUNDRAISING TO SUPPORT UNITED WAY AND WIN PRIZES! FRIDAY, SEPTEMBER 15 REGISTER YOUR TEAM NOW AND BEGIN FUNDRAISING TO SUPPORT UNITED WAY AND WIN PRIZES! TEAM CAPTAIN REGISTRATION FORM IMPORTANT: Please note that your $300 team registration fee must be

More information

NSW Medical Energy Rebate

NSW Medical Energy Rebate 1 This form is to be used by residents of on-supplied residential communities, retirement villages and strata schemes. $313.50 On-supplied is the term used when the resident receives an electricity bill/invoice

More information

Welcome to OPEN Gym. To book an induction please

Welcome to OPEN Gym. To book an induction please Welcome to OPEN Gym Induction Once you have completed your Gym Membership, Standing Order and Liability Disclaimer form as well as the Physical Activity Readiness Questionnaire (PARQ), the next thing you

More information

Change Champions & Associates presents: How to influence BEHAVIOUR CHANGE. in patients with chronic illness

Change Champions & Associates presents: How to influence BEHAVIOUR CHANGE. in patients with chronic illness Change Champions & Associates presents: How to influence BEHAVIOUR CHANGE in patients with chronic illness 2-day workshop with Elise Wald 21 & 22 May 2014 - Darwin, NT, Australia 09 & 10 June 2014 - Perth,

More information

Gym Memberships. The cost of the membership is per month, plus a one off cost of 5 for the band.

Gym Memberships. The cost of the membership is per month, plus a one off cost of 5 for the band. Gym Memberships Membership Form Name: Address: Membership Start Date: Payment Details The cost of the membership is 18.50 per month, plus a one off cost of 5 for the band. This Payment should be made either

More information

Devizes Amateur Swimming Club

Devizes Amateur Swimming Club MEMBERSHIP PACK 2014 Dear Member Welcome to the. This membership pack contains important safety information that we would ask you read carefully. For completion and return prior to membership Please complete

More information

Morgan Memorial Goodwill Industries Running for Great Kids 2017 Boston Marathon Team Application

Morgan Memorial Goodwill Industries Running for Great Kids 2017 Boston Marathon Team Application 1 Morgan Memorial Goodwill Industries Running for Great Kids 2017 Boston Marathon Team Application Applications will be accepted on a rolling basis. Send completed applications to: Erin Flaherty Barfield

More information

Membership Application PRACTITIONER Category

Membership Application PRACTITIONER Category Office use only Membership Application PRACTITIONER Category Member #... Invoice #... Date... To ensure accuracy of your details please print clearly Please note: There is a one-off joining fee of $35

More information

APPLICATION INSTRUCTIONS

APPLICATION INSTRUCTIONS APPLICATION INSTRUCTIONS TEACHER TRAINING PROGRAMS Application Deadlines To process your application, please send your complete application no later than one week prior to the program start date. However,

More information

Mandatory training requirements

Mandatory training requirements Section 5.0 Mandatory training requirements Content Summary Section No. Table of mandatory training requirements... 5.1 Mandatory Liquor Licensing... 5.1.1 Mandatory RSA and Online Training... 5.1.2 Training

More information

DIOCESE OF CORPUS CHRISTI

DIOCESE OF CORPUS CHRISTI Office of Youth Ministry DIOCESE OF CORPUS CHRISTI PO Box 2620 Corpus Christi, Texas 78403 (361) 882-6191 Fax (361) 693-6787 www.diocesecc.org/youth YouthOffice@diocesecc.org DIOCESAN CONFIRMATION RETREATS

More information

Video Relay Interpreting (VRI) via Skype

Video Relay Interpreting (VRI) via Skype On Demand Service Scheduled Booking Service Video Relay Interpreting (VRI) via Skype Victoria (SLC VIC) enables Deaf, hard of hearing and hearing people to communicate by providing interpreting services

More information

PENNSYLVANIA CERTIFICATION BOARD

PENNSYLVANIA CERTIFICATION BOARD PENNSYLVANIA CERTIFICATION BOARD ANNUAL CONFERENCE EXHIBITOR & SPONSORSHIP PROSPECTUS Annual Conference April 18-19, 2016 Harrisburg, PA ABOUT THE PCB ANNUAL CONFERENCE Don t miss your opportunity to participate

More information

Initial Clinical History and Physical Form

Initial Clinical History and Physical Form 601 E FM 544, Suite 400, Murphy, TX, 75094 TEL: 972-442-4700 Initial Clinical History and Physical Form Patient Information Name: Age: of Birth: / / Sex: Male / Female Marital Status: Single Married Divorced

More information

NA-019 LEVEL 3 QUALIFICATION RECOGNITION FOR AS3669 AND EN 4179 / NAS 410

NA-019 LEVEL 3 QUALIFICATION RECOGNITION FOR AS3669 AND EN 4179 / NAS 410 NA-019 LEVEL 3 QUALIFICATION RECOGNITION FOR AS3669 AND EN 4179 / NAS 410 Initial Qualification Recognition This procedure describes how the NANDTB recognises NDT Level 3 personnel qualifications as meeting

More information

MEMBERSHIP. Ireland s Philanthropic Society

MEMBERSHIP. Ireland s Philanthropic Society MEMBERSHIP Ireland s Philanthropic Society The RDS Ireland s Philanthropic Society A unique body A unique role By becoming a Member of the RDS you are joining a tradition that has supported Ireland for

More information

BEHAVIOUR CHANGE in patients with chronic illness

BEHAVIOUR CHANGE in patients with chronic illness How to influence BEHAVIOUR CHANGE in patients with chronic illness with Elise Wald 17 & 18 March 2014 (2 day workshop) RRMH Function & Convention Centre Seminar room 2, Melbourne, VIC Register online today!

More information

Please complete the medical history section below so that we can be sure to respond to any

Please complete the medical history section below so that we can be sure to respond to any 200hr Yoga Teacher Training Application Please fill out this form and email it to teachertraining@ahamyoga.com with Teacher training application 2016 as the subject line. Any enrollments without this form

More information

*To reserve your place in the training, you must submit the completed application along with a minimum

*To reserve your place in the training, you must submit the completed application along with a minimum APPLICATION INSTRUCTIONS The Epídavros Teacher Training programs includes a vigorous two-hour asana practice. We strongly recommend that applicants have one year of consistent asana practice. If your yoga

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Endorsement Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

19th National Professional Development Conference 10th - 12th October 2017 Gold Coast - Sofitel Broadbeach

19th National Professional Development Conference 10th - 12th October 2017 Gold Coast - Sofitel Broadbeach 19th National Professional Development Conference 10th - 12th October 2017 Gold Coast - Sofitel Broadbeach AN EXCITING SPONSORSHIP OPPORTUNITY CATSINaM is the national peak professional organisation representing

More information

Baby-Sitting - $20 Per Day/Per Nanny (local clients) Less than 24 hours notice $30 Per Day/Per Nanny. Hotel Overnight Sitting - $35 per Day/Per Nanny

Baby-Sitting - $20 Per Day/Per Nanny (local clients) Less than 24 hours notice $30 Per Day/Per Nanny. Hotel Overnight Sitting - $35 per Day/Per Nanny ALL ABOUT NANNIES BUSINESS PHONE: 602-266-9116 BUSINESS FACSIMILE: 602-266-9787 BUSINESS EMAIL: ADMIN@ALLABOUTNANNIESINC.COM TEMPORARY, BABY-SITTING, HOTEL & ON-CALL AS NEEDED Mother s Full Name: Place

More information

Tennis Australia Cardio Tennis Fitness Trainer Course

Tennis Australia Cardio Tennis Fitness Trainer Course Tennis Australia Cardio Tennis Fitness Trainer Course "Fitness clients love Cardio Tennis. When they find out they can burn up to 700 calories in one workout they are so keen to try it and when they do

More information

Welcome to Ballarat Pony club for the year

Welcome to Ballarat Pony club for the year Welcome to Ballarat Pony club for the year 2017-2018 Thank you for joining Ballarat Pony Club! We hope your family enjoys being part of the club and benefits from the many skills gained through participation

More information

IMPORTANT DATES AYBA 2018 Season

IMPORTANT DATES AYBA 2018 Season IMPORTANT DATES AYBA 2018 Season Walk In Registration / Uniform Fitting Euchre/Bowling Fundraiser Mail-In Registration January 10-11, 23 rd 6:30-8:30 p.m. @ Hideaway Lanes January 27 th Due by March 12

More information

2016 GPC National Championships & CPF Western Canadians Presented by Independent Powerlifting - Edmonton MDs: David Bennett and Tavis Harris

2016 GPC National Championships & CPF Western Canadians Presented by Independent Powerlifting - Edmonton MDs: David Bennett and Tavis Harris 2016 GPC National Championships & CPF Western Canadians Presented by Independent Powerlifting - Edmonton MDs: David Bennett and Tavis Harris Saturday, May 7 th and Sunday May 8 th, 2016 Evolve Strength

More information

TEAM NECC 2018 Boston Marathon

TEAM NECC 2018 Boston Marathon TEAM NECC 2018 Boston Marathon Contact: Beth McGonagle, Director of Operations bmcgonagle@necc.org 508-658-7571 The New England Center for Children is a private, nonprofit autism research and education

More information

Autism Society of Greater Orlando s 2018 Autism Walk & Family Fun Day **Annual Fundraising Event**

Autism Society of Greater Orlando s 2018 Autism Walk & Family Fun Day **Annual Fundraising Event** Autism Society of Greater Orlando s 2018 Autism Walk & Family Fun Day **Annual Fundraising Event** The Autism Society of Greater Orlando is hosting its 13 th Annual Autism Walk & Family Fun Day inside

More information

Tennessee Building Officials Association MEMBERSHIP APPLICATION

Tennessee Building Officials Association MEMBERSHIP APPLICATION Tennessee Building Officials Association MEMBERSHIP APPLICATION To join the Tennessee Building Officials Association (TBOA), please complete this entire application and return it to the TBOA with your

More information

Food Service Industry Membership

Food Service Industry Membership Coeliac Western Australia Food Service Industry Membership Page 1 About Who we are Coeliac Western Australia (CWA) is a not-for-profit organisation established in 1979 to assist and support people who

More information

Application to use Nutrition Australia Intellectual Property

Application to use Nutrition Australia Intellectual Property Application to use Nutrition Australia Intellectual Property All individuals, publishers and organisations must apply in writing to the Victorian Division for permission to use Nutrition Australia s Intellectual

More information

NA LEVEL 3 TECHNICAL QUALIFICATION RECOGNITION

NA LEVEL 3 TECHNICAL QUALIFICATION RECOGNITION NA-019 - LEVEL 3 TECHNICAL QUALIFICATION RECOGNITION Introduction This procedure reflects the adoption of the EN4179-2014 wording as Australian Standard AS3669, and describes the NANDTB processes when

More information

CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION AND EMERGENCY FORM

CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION AND EMERGENCY FORM CITY OF PINOLE TINY TOTS PROGRAM REGISTRATION Child's Name Date of Birth Parent/Guardian's Full Name Address Street: Address Line 2: City, State, Zip: Phone ( ) - Email EMERGENCY CONTACT INFORMATION OTHER

More information

Membership Application - Professional categories

Membership Application - Professional categories Office use only Member #... Invoice #... Date... Membership Application - Professional categories There is a non refundable administrative fee of $40 due with this application. If your application is successful,

More information

Details of Authorised Personnel

Details of Authorised Personnel Details of Authorised Personnel This form is to be used to register authorised personnel to act on behalf of your entity via the FishServe website and through the use of paper applications, documents and

More information

Autism Advisor Program NSW

Autism Advisor Program NSW What is the Autism Advisor Program? Information Sheet The NSW Autism Advisor Program offers the following support to families: information about autism spectrum disorders information about family support

More information

123rd Boston Marathon 2019 Charity Program Application

123rd Boston Marathon 2019 Charity Program Application 123rd Boston Marathon 2019 Charity Program Application RUN FOR PEACE OF MIND TEAM QUELL OUR MISSION The Quell Foundation strives to reduce the number of suicides, overdoses, and incarcerations of people

More information

Presents the IPA PRO WORLDS POWERLIFTING and BENCH PRESS CHAMPIONSHIPS

Presents the IPA PRO WORLDS POWERLIFTING and BENCH PRESS CHAMPIONSHIPS Presents the IPA PRO WORLDS POWERLIFTING and BENCH PRESS CHAMPIONSHIPS Saturday, 29th, April, 2017 Spring Street Academy 59 Spring St., Amherst, NS Canada YOU MUST HAVE MET THE QUALIFYING STANDARDS IN

More information

Sponsorship Opportunities

Sponsorship Opportunities Sponsorship Opportunities Saturday December 5, 2015 Broward College A. Hugh Adams Central Campus 3501 S.W. Davie Road Fort Lauderdale, FL 33314 Registration: 7:00 AM www.familycentral.org/5k2015 Who is

More information

APPLICATION FOR CIAPP CERTIFICATION

APPLICATION FOR CIAPP CERTIFICATION APPLICATION F CIAPP CERTIFICATION NAME E-MAIL POSTAL ADDRESS: Street City Province Postal Code TELEPHONE (WK HOME) I hereby apply for CIAPP certification in the category checked below. (For qualifications

More information

Washington County-Johnson City Health Department Christen Minnick, MPH, Director 219 Princeton Road Johnson City, Tennessee Phone:

Washington County-Johnson City Health Department Christen Minnick, MPH, Director 219 Princeton Road Johnson City, Tennessee Phone: Washington County-Johnson City Health Department Christen Minnick, MPH, Director 219 Princeton Road Johnson City, Tennessee 37601 Phone: 423-975-2200 Dear Parent: The Washington County Health Department

More information

Saturday & Sunday, July 18-19

Saturday & Sunday, July 18-19 proudly present: Saturday & Sunday, July 18-19 RULES OF PERFORMANCE SQUAT: The lifter shall face the front of the platform. The bar shall be held horizontally across the shoulders, hands and fingers gripping

More information

Sponsorship Prospectus

Sponsorship Prospectus Queensland Pest Animal Symposium 2012 30 July 2 August 2012 Sunshine Coast Function Centre, Caloundra, Queensland Sponsorship Prospectus Symposium Office PO Box 3873, South Brisbane BC QLD 4101 2A/15 Anthony

More information

Part I Application- Route 4

Part I Application- Route 4 2018 American Board of Oral Implantology/Implant Dentistry 211 East Chicago Avenue, Suite 750-B Chicago, Illinois 60611-2616 Phone: 312-335-8793 Fax: 312-335-9045 Part I Application- Route 4 First MI Last

More information

ROYAL SOLENT YACHT CLUB Application for Membership

ROYAL SOLENT YACHT CLUB Application for Membership ROYAL SOLENT YACHT CLUB Application for Membership Please return to: The Secretary, Royal Solent Yacht Club, The Square Yarmouth, Isle of Wight, PO41 0NS. Office: (01983) 760256 Fax: (01983) 761172 Email:

More information

14 Month. Personal Details

14 Month. Personal Details 14 Month PAGE 1 REPs Registration Application Form 2017-2018 From 1 July 2017 to 30 September 2018! IMPORTANT - Please read this before you start. To successfully complete your application, you MUST HAVE

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions These were updated on March 2018. 1. Details of revised Scheme from 4 April 2018 We are retaining the higher level of award ( 1,000) for childminders who care for children with

More information

September 13 16, 2017 Participant & Non-Participant REGISTRATION FORM

September 13 16, 2017 Participant & Non-Participant REGISTRATION FORM Page 1 of 6 September 13 16, 2017 Participant & Non-Participant REGISTRATION FORM REGISTRATION DEADLINE: JULY 28, 2017 SECTION 1 PERSONAL INFORMATION (Please Print Clearly) LAST NAME: FIRST NAME: CIVIC

More information

TROY YOUTH FOOTBALL ASSOCIATION TROYCOWBOYS 2018 REGISTRATION FORM

TROY YOUTH FOOTBALL ASSOCIATION TROYCOWBOYS 2018 REGISTRATION FORM TROYCOWBOYS 2018 REGISTRATION FORM Registration Fees Flag : $160 Freshman - JV: $180 Varsity : $150 Participant Information Name: Address: Date of Birth: City: Zip Code: Mother s Cell Number: Parent/Guardian

More information

PROGRAM YEAR 2018 REGISTRATION PACKAGE

PROGRAM YEAR 2018 REGISTRATION PACKAGE PROGRAM YEAR 2018 REGISTRATION PACKAGE Full Stride Track Club is a competitive track club for Contra Costa and Solano County youth ages 5 to 18 years old. We are committed to providing our youth with a

More information

National Certification Board

National Certification Board ISNT Membership No. National Certification Board ISNT Level III Certification Application ID No: Non ISNT Members should fill in the enclosed Membership Form and Select the option in the table below for

More information

How to order. Why buy a gift?

How to order. Why buy a gift? Deaf Action is an Australian organisation assisting deaf communities in developing countries to gain the education and life skills needed to overcome their disability and live productive lives. With your

More information

2017 Joint Annual Conference Exhibit and Sponsorship Program

2017 Joint Annual Conference Exhibit and Sponsorship Program 2017 Joint Annual Conference Exhibit and Sponsorship Program April 27-28, 2017 Double Tree Chicago Oak Brook, Illinois Don t miss this opportunity to reach your target market. Take advantage of these convenient,

More information

Responding to Complexity SPONSORSHIP & TRADE PROSPECTUS NIDAC18. Stamford Plaza Adelaide 6 November 2018 Adelaide Convention Centre 7-9 November 2018

Responding to Complexity SPONSORSHIP & TRADE PROSPECTUS NIDAC18. Stamford Plaza Adelaide 6 November 2018 Adelaide Convention Centre 7-9 November 2018 NIDAC18 5th National Indigenous Drug & Alcohol Conference SPONSORSHIP & TRADE PROSPECTUS Responding to Complexity Stamford Plaza Adelaide 6 November 2018 Adelaide Convention Centre 7-9 November 2018 Conference

More information

DIOCESE OF CORPUS CHRISTI

DIOCESE OF CORPUS CHRISTI Office of Youth Ministry DIOCESE OF CORPUS CHRISTI 620 Lipan St. Corpus Christi, Texas 78401 (361) 882-6191 Fax (361) 693-6787 www.diocesecc.org/youth YouthOffice@diocesecc.org DIOCESAN CONFIRMATION RETREATS

More information

VITAL SIGNS EMS CONFERENCE 2017 EXHIBITOR APPLICATION FORM

VITAL SIGNS EMS CONFERENCE 2017 EXHIBITOR APPLICATION FORM VITAL SIGNS EMS CONFERENCE 2017 EXHIBITOR APPLICATION FORM Company Name: Company Address: City: State: Zip Code: Contact Person: Telephone Number: Fax Number: Tax ID #: E-Mail Address: We will issue exhibitor

More information

INTERNATIONAL VISITING RESEARCH PROGRAM (IVRP) APPLICATION

INTERNATIONAL VISITING RESEARCH PROGRAM (IVRP) APPLICATION INTERNATIONAL VISITING RESEARCH PROGRAM (IVRP) APPLICATION RSIA Form I-0008: Rev. 20170206330 WELCOME! MISSION STATEMENT Gallaudet University Gallaudet University, federally chartered in 1864, is a bilingual,

More information

Go RED for Redkite Kit

Go RED for Redkite Kit - 1 - Go RED for Redkite Kit Your local Redkite office: Sydney: PO Box 3220 Redfern NSW 2016 phone 02 9219 4000 Perth: Lwr Grd Flr, 229 Stirling Highway Claremont WA 6010 phone 08 9384 7966 Melbourne:

More information

NEW PATIENT PAPERWORK

NEW PATIENT PAPERWORK NEW PATIENT PAPERWORK Welcome! Please fill out the necessary paperwork provided. It is our pleasure to serve you and your family. How did you find out about us? If It was a friend or doctor, please list

More information

The University of Michigan

The University of Michigan Tryout Directions and Information: The University of Michigan This packet contains the following forms that must be completed before your tryout can begin: Tryout clearance form You only need to fill out

More information

Support RP Fighting Blindness by taking part in our 2016 Superhero Run!

Support RP Fighting Blindness by taking part in our 2016 Superhero Run! Support RP Fighting Blindness by taking part in our 2016 Superhero Run! Thank you for requesting a Do it for Charity Superhero Run information pack. We can t wait for you to join us in becoming a real-life

More information

Hello, Fundraiser! All the best, Julie Lowe Ronald McDonald House Charities of Greater Washington, DC

Hello, Fundraiser! All the best, Julie Lowe Ronald McDonald House Charities of Greater Washington, DC Hello, Fundraiser! We are so excited to work with you on your fundraising event in support of Ronald McDonald House Charities of Greater Washington, DC and help Raise Love for the families we support!

More information

Application for Special Licence (for premises)

Application for Special Licence (for premises) District Office 15 Galileo Street Private Bag 544 Ngaruawahia 3742 Huntly Area Office 142 Main Street 0800 492 452 Raglan Area Office 7 Bow Street 07 825 8129 Tuakau Area Office 2 Dominion Road 0800 492

More information

DECISION SCIENCES INSTITUTE 2018 ANNUAL MEETING November 17 19, 2018 Chicago Hilton 720 South Michigan Avenue Chicago, Illinois, 60605

DECISION SCIENCES INSTITUTE 2018 ANNUAL MEETING November 17 19, 2018 Chicago Hilton 720 South Michigan Avenue Chicago, Illinois, 60605 DECISION SCIENCES INSTITUTE 2018 ANNUAL MEETING November 17 19, 2018 Chicago Hilton 720 South Michigan Avenue Chicago, Illinois, 60605 Decision Sciences Institute is a professional organization of academicians

More information

Information for applicants for Special Licence

Information for applicants for Special Licence Information for applicants for Special Licence A building consent may be required before a special licence is issued if you intend to use a building that is not normally used as a licensed premises and/or

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Exam Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing: Scaled:

More information

Veterinary Acupuncture

Veterinary Acupuncture A U S T R A L I A N I V A S Veterinary Acupuncture Integrate Acupuncture into your practice in 2012! Course January-December, 2012 Course Information Guide ABOUT THE COURSE Integrate acupuncture into your

More information

EXTERNAL TRAINER AGREEMENT. THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and -

EXTERNAL TRAINER AGREEMENT. THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and - EXTERNAL TRAINER AGREEMENT THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and - 2566588 Ontario Ltd. operating as Fortis Fitness West (2566588 Ontario Ltd. operating as Fortis

More information

Falkirk Otter Amateur Swimming Club Privacy Notice

Falkirk Otter Amateur Swimming Club Privacy Notice Background Falkirk Otter Amateur Swimming Club Privacy Notice Falkirk Otter ASC (the Club ) is a competitive, not-for-profit swimming club run by a group of coaches and a committee formed from parent volunteers.

More information

Requirements for the Childcare Register: childminders and home childcarers

Requirements for the Childcare Register: childminders and home childcarers Requirements for the Childcare Register: childminders and home childcarers A childcare factsheet This guidance describes the requirements set out in regulations for both parts of the Childcare Register

More information

EXTERNAL TRAINER AGREEMENT. THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and -

EXTERNAL TRAINER AGREEMENT. THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and - EXTERNAL TRAINER AGREEMENT THIS AGREEMENT dated as of the day of, 20. BETWEEN: (the External Trainer ) - and - Fortis Fitness Inc. (Fortis Fitness Inc. or Fortis Fitness or the Companies ) This Agreement

More information

Making Better Decisions Mistakes, Biases, Irrational Effects and Inspired Genius!

Making Better Decisions Mistakes, Biases, Irrational Effects and Inspired Genius! Making Better Decisions Mistakes, Biases, Irrational Effects and Inspired Genius! One-day Workshop Friday 15 August 2008 9.00am 4.30pm Northern Sydney Education Centre Macquarie Hospital Wicks Road North

More information

Lions Sight & Hearing Foundation Phone: Fax: Hearing Aid: Request for assistance

Lions Sight & Hearing Foundation Phone: Fax: Hearing Aid: Request for assistance Lions Sight & Hearing Foundation Phone: 602-954-1723 Fax: 602-954-1768 Hearing Aid: Request for assistance 3427 N 32 nd Street office use only Date received Case number Applicant: (Name; please print clearly)

More information

Exhibitors and Sponsors Information and Forms. Texas Aquatic Plant Management Society 2015 Annual Conference Tapatio Springs October 12-14, 2015

Exhibitors and Sponsors Information and Forms. Texas Aquatic Plant Management Society 2015 Annual Conference Tapatio Springs October 12-14, 2015 Exhibitors and Sponsors Information and Forms Texas Aquatic Plant Management Society 2015 Annual Conference Tapatio Springs October 12-14, 2015 The Texas Aquatic Plant Management Society invites you to

More information

BIG BIKE CHALLENGE TWO DAY RIDE: MANCHESTER TO SOUTHAMPTON

BIG BIKE CHALLENGE TWO DAY RIDE: MANCHESTER TO SOUTHAMPTON BIG BIKE CHALLENGE TWO DAY RIDE: MANCHESTER TO SOUTHAMPTON We know that many of our previous participants were interested in completing the distance over two days, and so, we are also offering Manchester

More information

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure

North Carolina Board of Physical Therapy Examiners Application for Physical Therapist Licensure FOR OFFICIAL USE ONLY Name: End: Ex: Rev by End: Exost: Board Approved by: PT Revive by Exam Application Examination Date: / / ID Number: / / Exam Form Number: / / SCORES: Scaled: / / Raw: / / NC Passing:

More information

Alzheimer s Arkansas Walks 2017 Individual or Team Registration Form

Alzheimer s Arkansas Walks 2017 Individual or Team Registration Form Alzheimer s Arkansas Walks 2017 Team Registration Form Yes, I/we will form a participate in (please check) Russellville 8/19 Helena 9/9 Hot Springs 9/16 Little Rock 10/7 Conway 10/28 This registration

More information

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines DENTAL CLAIM FORM Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines OFFICE USE ONLY Claim number Reference COMPLETE THIS FORM IF You

More information

AHRA 2019 Spring Conference Marriott Plaza San Antonio San Antonio, TX March 7 9, 2019 Exhibitor Information

AHRA 2019 Spring Conference Marriott Plaza San Antonio San Antonio, TX March 7 9, 2019 Exhibitor Information Exhibitor Information Who is the audience? Hospital Medical Imaging Directors and Imaging Center Administrators, Radiologists, Business Managers, PACS Administrators, Radiologic Technologists, Coders/Billers,

More information

Fundraising Information Packet

Fundraising Information Packet Fundraising Information Packet Contact: Down Syndrome Association For Families of Nebraska Lincoln NE 68505 www.dsafnebraska.org Email: stepupwalk@dsafnebraska.org (402) 421-1338 Page 1 Dear Team Captain,

More information

July Dear Surgical Supplier:

July Dear Surgical Supplier: July 2016 Dear Surgical Supplier: As President of the Southern California Chapter of the American College of Surgeons, I invite you to participate in our annual scientific meeting at the Four Seasons Biltmore,

More information

Team Registration For more information, call 613-542-6222 or email events@epilepsyresource.org Participant Information Epilepsy South Eastern Ontario is a non-profit charitable organization dedicated to

More information

Date of Birth IC/Passport Number Nationality Gender. Telephone Number Mobile Phone Number Guardian Telephone Number (Mandatory for Under-18 s)

Date of Birth IC/Passport Number Nationality Gender. Telephone Number Mobile Phone Number Guardian Telephone Number (Mandatory for Under-18 s) CAMBRIDGE ASSESSMENT INTERNATIONAL EXAMINATIONS INTERNATIONAL GENERAL CERTIFICATE OF SECONDARY EDUCATION IGCSE-EXAMINATIONS OCT/NOV 2018 Centre Name LEAVE FOR OFFICIAL USE Centre Number Candidate Number

More information

2018 Business Associate Sponsorship Options

2018 Business Associate Sponsorship Options 2018 Business Associate Sponsorship Options P.O. Box 790 - Sherwood, OR 97140 Phone (678) 523-5915 - Fax (877) 872-3493 - Email: main@ohiomgma.com - www.ohiomgma.com members are healthcare leaders and

More information

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register

FACILITATOR TRAINING. TO REGISTER See pages 2-7 for more information and to register FACILITATOR TRAINING DATES & LOCATIONS Wednesday, September 14, 2016 Chicago, IL Wednesday, November 9, 2016 Springfield, IL Wednesday, November 16, 2016 Chicago, IL* Wednesday, March 15, 2017 Chicago,

More information

guide to fundraising Good Friday Appeal Fundraising Guide

guide to fundraising Good Friday Appeal Fundraising Guide Your guide to fundraising 1 Contents 3 5 6 7 8 9 10 11 12 13 14 Thank you The Hospital in numbers 5 easy step to fundraising Fundraising ideas What your fundraising supports Online fundraising Meet our

More information