2016Go for 2&5 GWA JUDGE EDUCATION

2016Go for 2&5 GWA JUDGE EDUCATION

ACCREDITATION COURSE APPLICATION FORM

Please read Gymnastics Western AustraliaEducation Policyprior to completing this form.

Course Details

Gymsport
(please tick) / / / / / /
MAG / WAG / RG / AER / TRP / ACR
Course Name / (Refer to Education Calendar)
Course Date / (Refer to Education Calendar)

Personal Details

Name / DOB
Address
Postcode
Contact Details / (H) / (W)
(E) / (M)
Affiliated Club (if any)
Club Involvement / Parent Athlete
Accredited Coach/Judge (provide ID No. - )
Course Fees / Full / Concession / Observer / GymSport/s
Beginner / $80.00 / $60.00 / $35.00 / MAG/RG/TRP/ACR/WAG/AER
Intermediate / $150.00 / $112.50 / $70.00 / MAG/RG/TRP/ACR/WAG
Intermediate / $80.00 / $60.00 / $35.00 / AER
Intermediate Bronze / $105.00 / $78.50 / $40.00 / MAG/RG/TRP/ACR
Advanced – 1 day / $105.00 / $78.50 / $40.00 / AER/ACR
Advanced – 2 day / $192.00 / $144.00 / $70.00 / MAG/WAG/RG/TRP
Advanced Silver / TBC / TBC / TBC

Conditions – Please tick

I have read the GWA Education Policy Document

Student Concession – (Please Tick)

I have attached a copy of my current student card or letter of enrolment

Payment

Course Fee / $ / Inc GST
Total Payment Amount / $ / Inc GST
OR please debit my Credit Card / Card Type / VISA MASTERCARD
Card Number / / / / / Expiry Date / /
Name on Card / Payment Amount / $ / Inc GST

Updated 16/12/2015 (All prices include GST)

Please be advised all education confirmation letterswill be sent out via email, please ensure you provide GWA with your email address on the application form.

Gymnastics WA – State Gymnastics Centre, 99 Loftus St, Leederville - PO Box 1204, West Leederville, WA 6901

Ph 08 9228 9399 - Fax 08 9228 9499 - - - ABN 35 014 656 688