Application Form

For Applicants Under 18 yrs

Parent Name:

Parent Phone: ( )

1. Applicant Information:

Name:

Address:

Home: ( ) Cell: ( )

Birthdate (yyyy-MM-dd): Email:

Cycling BC Member Number:	Cycling Discipline: Ability Category:

2. Carding Level Sought:

Have you raced as member of Cycling Canada Senior or Development Team?

Are you currently receiving support from the Sport Canada Athlete Assistance Program?

Indicate the level of carding sought:

Canadian Development	1	1A

Provincial Development	2	3

Applicant Training and Performances in Support of the level sought:

Attach a copy of the following to this application

Season plan for your upcoming training & competition

Race results from significant competitions in the last 12 months

(these may include Provincial/National Championships, World Cups, World Championships, or continental and domestic regional events – substitution of equivalent events at the discretion of Cycling BC)

Results from fitness/performance testing in the last 12 months

(tests must use published Cycling Canada or Cycling BC protocols and be conducted by approved experts)

3. Coach Information:

Name:

Address:

Home: ( ) Cell: ( ) Email:

Cycling BC Member Number: NCCP Level: CC#:

4. Requirements for Successful Applicants:

Services for carded athletes - members of Team BC - are provided through the Canadian Sport Centre Pacific and PacificSport Network of regional centres to assist in training and pursuit of sport excellence. Athletes selected for carding are responsible to register with the Canadian Sport Centre Pacific and PacificSport in accordance with the instructions that will be provided upon notification of selection. Failure to register or utilise the services offered by Canadian Sport Centre Pacific or PacificSport Centres after selection may affect future eligibility for carding.

Athlete Signature: Date:

Applications must be received at the Cycling BC office by fax (604) 737-3141 or email to performance@cyclingbc.net no later than 4:00pm on Nov 29, 2012.