Entry Form, PESA South Australia 2022

Plain English Speaking Award - South Australia

Entry Form and Personal Profile, for Students aged at least 15 years and under 18 years on the 1st of January 2023.
Name of Entrant *

First Name Last Name
Date of Birth *

Day Month Year
Year Level *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone *
Please enter your mobile phone number.
Email Address *
e.g. modelstudent@school.edu.au
Name of School *
Address of School *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone of School *

Area Code Phone Number
Contact Teacher's Email Address *
e.g. wonderfulteacher@school.edu.au
Principal's Name *
Entrant's Interests *
Entrant's Ambitions *
Entrant's Special Achievements *
Preferred Heat Time *

Wednesday 18th May (4.30pm) Thursday 19th May (4.30pm) Friday 20th May (5.30pm) Saturday 21st May (10.00am)
Title of Entrant's Speech (Optional)
I have read the conditions of entry and agree to abide by them. (Student) *

Clear
Date of Signature *

Day Month Year
I have read the conditions of entry and agree to abide by them. (Parent/Guardian) *

Clear
Date of Signature *

Day Month Year
Please submit this form with the entry fee of $20 no later than 7th of May. The payment details for the entry fee are:

BSB: 105-134 Bank SA
Account Number: 054998940
Account Name: Plain English Speaking Award
Reference: Name of Entrant
Should be Empty:

Plain English Speaking Award - South Australia