TRAVEL GRANT APPLICATION FORM

Name

First Name

Last Name

Text Area

World Championship Events to be attended ie name, venue and date

Text Area

List local events you have participated in the last 12 months. ie WA State Championship, Club Championship and YWA Events and your placings in each.

Text Area

Describe how you or members of your immediate family have contributed to promote the Class at Club or Association level in the previous 12 months. eg Committee, volunteer coaching, race day duties.

Event report

I agree to provide a written report with photos or video suitable to be placed on the WALA/FaceBook websites within one month of conclusion of the Event. Report to include:- • My participation and performance throughout the event; • The organisation of the Event including highlights, and lowlights with recommendations. • Lessons learnt.

YES

Payment

I acknowledge that payment of the Travel Grant will occur only after completion of the Event and submission of a written report and photos.

YES

Parent/Guardian

Endorse application if applicant under 18 years of age

YES

Bank Account Name

Bank Details to enable funds transfer to you

Bank Account BSB Number

Add Details to enable funds transfer to you

Account Number

To enable funds transfer to you

Date of Application

YYYY