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2014 Licence Form: Your Details (Please Tick Where Applicable)

The document is a 2014 license form for Athletics South Africa that collects personal details such as name, address, date of birth, club, and emergency contact information. It requires signatures to confirm the provided information is accurate and that the applicant agrees to abide by Athletics South Africa's rules and regulations.

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abstickle
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17 views

2014 Licence Form: Your Details (Please Tick Where Applicable)

The document is a 2014 license form for Athletics South Africa that collects personal details such as name, address, date of birth, club, and emergency contact information. It requires signatures to confirm the provided information is accurate and that the applicant agrees to abide by Athletics South Africa's rules and regulations.

Uploaded by

abstickle
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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2014 LICENCE FORM

The completeness and accuracy of this submission, helps to improve Athletics South Africa's service to you. Identification ID Document Birth Certificate Passport Refugee Permit

Licence Number (2013) Club Name (in full)

Licence Number (2014)

Please enter the relevant number ASA Province

Athlete Track & Field Title (Mr/Ms/Dr etc) Surname

Coach Cross Country First Name

Technical Official Road Running Race Walking Trail Running

Your Details (Please tick where applicable)

Initials

E-mail Address

Date of Birth (DD/MM/YYYY) Home Language English Tswane Occupation Residential Address - Domicilium Rule

/
Sotho Pedi

/
Xhosa Tshonga Zulu

Gender:

Male

Female

Afrikaans Venda

Other (Specify) .

Postal Address

Tick if the same as Residential

Code Tel Number (Home) Tel Number (Work)

Code Cell Number

Emergency Contact: (Please supply two) Name Name

Tel Tel

I declare that I am a bona fide athlete/coach/technical official. I confirm that all the information provided on this application is true and correct. I subject myself to the rules and regulations of Athletics South Africa and the IAAF, and I undertake not to compete in any athletics event which is not sanctioned by the provincial athletics body and ASA. I indemnify ASA, the provincial body, sponsors and organisers of any event against all and any action of whatever nature which may arise out of my participation and I agree that it is my responsibility to be medically fit to compete in any event.

Date Signature of Parent/Guardian (Younger than 18yrs) Signature of Club Representative Signature and stamp of the Province

Signature.. Signature.. Signature.. Signature..

Welcome to the Athletics South Africa Family

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