NAME OF APPLICANT	______________________________			RECIEPT REQUIRED : [___]
ADDRESS	______________________________			POST CODE : ____________
PHONE	_____________
VENUE PREFERENCE	CIA : [___]	SKATERS ON ICE :	[___]	EITHER :	[___]

 

I hereby apply to attempt the National Test:	________________________________________________
	(State which test.)

	I enclose the test fee of $ _______ cheque. (Cheques to be made payable to The Western Australian Ice Skating Association (WAISA).
NOTE	One test only per application form. If more than one test is to be attempted, a separate form is required for each test. Dates and Times of National Tests will be advised to the respective couch and displayed on the Ice Rink notice board.
DECLARATION BY APPLICANT (to be countersigned by parent or guardian if the applicant is under 18)
I hereby declare that I am a current financial member of WAISA and the information I have provided on this form is to the best of my knowledge true and accurate. I aknowledge that National Tests are tests of proficiency conducted by the WAISA on behalf of and in accordance with the procedures and requirements of Ice Skating Australia (ISA). I agree to abide by the decision of the test Judges/Referee and the appropriate rules, regulations and procedures of the WAISA and ISA.

Signature of Applicant:	__________________________________________________	Date:	__________________
Signature of Coach:	__________________________________________________
Signature of Parent/Guardian:	__________________________________________________
	(if the applicant is under 18)
This application must be posted to WAISA Inc. Test Application, P O Box 1472, Bibra Lake WA 6965