APPLICATION FOR REPRESENTATIVE COACHES, SELECTORS AND MANAGERS 2012 SEASON

Applications close Friday 25 November 2011

Send form to:

The Administrator

Mid Canterbury Netball

PO Box 372

ASHBURTON  Fax 03 3084685 or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it

I ____________________________________________ wish to apply for the following

(indicate weather coach, selector or manager)

Team/s applying for – please circle.  (If you tick more than one it would indicate the applicant is prepared to be available for consideration over more than one team.  Please indicate the order of preference if applying for more than one team, eg 1, 2, 3 - appointment however would normally be to one team only.

Coach              Selector            Manager                       Preference

Mid Canterbury A _________      ________        ____________            _________

Mid Canterbury U17 _________     ________        ____________            _________

Mid Canterbury U15 _________     ________        ____________            _________

Mid Canterbury U14 __________    ________        ____________            _________

Mid Canterbury Junior A _________      ________        ____________            _________

Mid Canterbury Junior B _________      ________        ____________            _________

Mid Canterbury Junior Dev_________        ________        ____________            _________

Applicant’s address: ……………………………………………………………………………

Phone: ……………………….. e-mail address: …………………………………………….

Previous experience/qualifications:

Signed: _________________________ (applicant)     Date: __________________

By signing this form I give Mid Canterbury Netball my consent to retain this information to use and distribute for the purposes of administration.  This consent is given under the 1993 Privacy Act.