27th Summer Universiade
Kazan, Russia.
6 – 17th July 2013
th
Nomination Form.
Position: Assistant Head of Delegation
CUSAI
IMPORTANT NOTE: Please complete this form BY COMPUTER, returning a soft / email copy to
[email protected] and a signed hardcopy to the CUSAI Office (address above) by 12 noon on the 16th March,
2012.
SECTION A – Personal Details
(to be completed by the person being nominated)
Surname
Date of birth (dd/mm/yyyy)
First name
Place of birth
Title
Sex
Nationality
Height (cm)
Weight (kg)
Home Address
Home Telephone
Home Fax
Work Address
Work Telephone
Work Fax
Mobile
Email address(es)
Gear sizes
Tracksuit
men – S / M / L / XL / etc.
ladies – 10 / 12 / 14 / etc.
Shorts
men – S / M / L / XL / etc.
ladies – 10 / 12 / 14 / etc.
SECTION B – Passport Details
T-shirt / Polo-shirt
men – S / M / L / XL / etc.
ladies – 10 / 12 / 14 / etc.
Trainers
men – UK size
ladies – UK size
(to be completed by the person being nominated)
Passport no.
Passport issuance date
Passport expiry date
Passport issuing authority
SECTION C – Relevant Experience
(to be completed by the person being nominated)
Please give full details of relevant experience / qualifications / etc.
SECTION D – Declaration
(to be completed by the person being nominated)
I wish to be considered for the position of ____________________________ to the CUSAI delegation for the 27th
Summer Universiade in Kazan, Russia from the 6th – 17th July 2013. I have read and understood CUSAI’s document
entitled “Guidelines for CUSAI Team Managers and Coaches”.
Name (BLOCK CAPITALS)
Signature
Date
SECTION E – Support information
(to be completed by the institution / organisation submitting nomination)
Please give information in support of the Candidate
Institute / Organisation submitting nomination
(to be completed by the institution / organisation submitting nomination)
Nominated by (person)
(BLOCK CAPITALS)
Institute /
Organisation
stamp
Signature
Institute / Organisation
Date
CLOSING DATE: 12 Noon, Friday, 16th March 2012
Please send hardcopy of this
Nomination Form by post to –
Please also send soft / email copy of
this Nomination Form to –
CUSAI
Sport HQ
Unit 13, Joyce Way
Park West Business Park
Dublin 12
[email protected]
For office use only
Received: