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AIR Short Track Excellence Program Application
This application registers your interest to become a member of AIR STEP and to be involved in the activities associated with the program, whether being based in Melbourne or visiting the program from time to time for dedicated training opportunities.
All application approvals will be at the sole discretion of Australian Ice Racing.
If the applicant is under the age of 18-years, a parent should complete this form on the child's behalf.
Name
*
First
Last
Date of Birth
*
DD
/
MM
/
YYYY
Current Age
*
Email Address
*
Confirm
Phone
*
###
-
###
-
####
Parent Details (if under 18)
First
Last
Parent Phone
###
-
###
-
####
Club and State
*
Please select
Blades IRC (QLD)
Roos IRC (QLD)
Western Flame IRC (WA)
Sydney Arrows IRC (NSW)
Sydney Speed Skating Club (NSW)
Dockland Demons IRC (VIC)
Olympic Southern Flyers IRC (VIC)
International
If International, please advise of Nation and Club
Best times in previous 6-months (Require two times)
Time
Date
Event/Venue
Protocol Link (if available)
500m
777m (Sub-Junior only)
1000m
1500m
My Competition Experience
*
Club Racing
State Championships
Australian National Championships
Duke Trophy
Star Class Series
Danubia Series
Other National Championships
Other International Competitions
World Cup
World Junior Championships
World Championships
Olympic Winter Games
Have you previously been a member AIR STEP or AIR J-STEP?
*
Please select
Yes
No
Do you have a previous AIR JDP or EDP racing suit?
*
Please select
Yes
No
I am applying for:
*
Please select
J-STEP
STEP
Both J-STEP and STEP
If not planning to reside in Melbourne full-time, or you do not reside in Melbourne, do you have any specific dates you are planning to train with the AIR STEP if approved?
I declare that the information provided on this electronic form is true and correct to the best of my knowledge and belief and that I submit this form knowing that supplying false information creates an integrity offence against the AIR Code of Conduct that may see me excluded from the AIR STEP.
I understand that where a benefit of any sort is obtained by the submission of knowingly false information, this creates a criminal offence.
I agree to abide by all AIR policies and procedures, program rules, and to be positive in my encounters with all members of our sport.
I undertake to pay the agreed training fees associated with the AIR STEP on time, and understand that failure to pay the fees may see me immediately denied access to the program.
I acknowledge that if I breach any of the program rules, I can be immediately removed from the program and forfeit any paid fees to that point.
I acknowledge that AIR fully reserves the right to decline any application without explanation.
(If under the applicant is under 18, where the parent completes this form, ticking the acknowledgement will indicate that you have explained the above details to your child.) I also acknowledge that I have read the rules in the AIR STEP document and agree to abide by them whilst a member of the program
*
I acknowledge I have read and understand the above declaration and further declare that I have not knowingly submitted false or fabricated information to gain a benefit or falsely represent my (or my child's) achievements in ice speed skating.
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