Who would you like to nominate for assistance? Which event would they like to participate in?*Mt MaunganuiRotoruaSouth AucklandCentral West AucklandCentral East AucklandHastingsHamiltonGisborneChristchurch AMChristchurch PMDunedinNelsonHutt CityWellingtonPalmerston NorthHibiscus CoastNew PlymouthBay of IslandsNominated Group Type:*Church groupGirl GuidesSchool groupScoutsSports clubOtherSchool decile:12345678910OtherSchool role: Nominated Group Name:* Nominee Email Address:*This will be used to contact your nominee if your application is successful. Nominee Contact Phone Number:*This will be used to contact your nominee if your application is successful. Your detailsYour Name:* Your relationship to the nominee:*Community Group LeaderFriendGroup AdministratorTeacherOtherOther Your Email Address:*This will be used to contact you if your application is successful. Your Contact Phone Number:*This will be used to contact you if your application is successful. Group Nomination DetailsI would like my nominated group to receive:* Assistance with the cost of participant registration fees. Assistance with obtaining the equipment necessary to participate. How many subsidised entries does your nominated group require?* What equipment does your nominated group need assistance with obtaining?* Bicycles Helmets Running shoes Other Other How many participants does your nominated group require this equipment for?* If this equipment cannot be purchased on behalf of the nominee, would having this equipment hired for use on the event day still be useful?* Yes No Why do you believe your nominated group deserves to receive assistance?*Why would the group you are nominating not otherwise be able to enter the event?*What other activities is your nominated group undertaking to assist with entry into the event?*Individual Nomination DetailsI would like my nominee to receive:* Assistance with the cost of participant registration fees. Assistance with obtaining the equipment necessary to participate. What equipment does your nominee need assistance with obtaining?* Bicycle Helmet Running shoes Other Other If this equipment cannot be purchased on behalf of the nominee, would having this equipment hired for use on the event day still be useful?* Yes No Why do you believe your nominee deserves to receive assistance?*Why would the candidate you are nominating not otherwise be able to enter the event?*What other activities is your candidate undertaking to assist with entry into the event?*Have you submitted a nomination to the Weet-Bix TRYathlon Foundation before?*YesNoDisclaimers* I have obtained the consent of the nominee's parents or legal guardian(s) to make this nomination. * * I understand in submitting this application that an application does not constitute an obligation on behalf of the Weet-Bix Kids TRYathlon Foundation. * * I understand that by making a submission for assistance, to the Weet-Bix Kids TRYathlon Foundation on behalf of the Nominee(s) above, I consent to being contacted (electronically or otherwise) with regards to this application. I also consent to my nomination, name and image being used for publicity purposes relating to the work of the Foundation, subject to the consent of the nominee's parent or guardian. * NameThis field is for validation purposes and should be left unchanged.
