2025 Unisport Nationals

2025 Unisport Nationals

Personal Information
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Student ID Number*
FAN*
Date of Birth*

DayMonthYear
Date
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course of Study*
Expected year of study completion*
Participation Status*

AthleteTeam ManagerTeam CaptainOther
Event*

AthleticsTriathlonSwimmingIndigenous NationalsDistance RunningT20 CricketNationals
Choose Event*

100m200m400m800m1500m5,000m10,000m4 x 100m Relay4 x 400m4 x 400m Relay3,000m Steeple5,000m Walk100m Hurdles400m HurdlesLong JumpPole VaultHammerHigh JumpDiscusTriple JumpShot PutJavelin
Chosen Sport*

Basketball - MensBasketball - WomensBeach Volleyball - Womens PairsBeach Volleyball - MixedBeach Volleyball - Mens PairsFutsal - Women'sJudo - WomensJudo - Men'sKendo - MixedLacrosse - MixedNetball - MixedNetball WomensRowing - MensRowing - WomensSquash - MixedTaekwondo - WomensTaekwondo - Men'sTennis - Men'sTouch Football - MixedTouch Football - WomensVolleyball - MensVolleyball - Womens
Medical Information
Medicare Number*
Medicare Reference Number*
Medicare Valid Date*

DayMonthYear
Date
Health Care Provider & Membership Number*
Emergency Contact*

First NameLast Name
Relation*
Mobile Number*
Please enter a valid phone number.
Work Number*
Please enter a valid phone number.
Pre-existing Health Condition(s)*
Medication to travel with (i.e puffer for asthma)*
Allergies*
Current/Niggling Injuries*
Bank Details (For uniform bond refund if required)
Account Name:*
BSB:*
Account Number:*
Additional Info
Polo Size*

XSSMLXLXXL
I have read and understood the Participation Agreement, therefore by ticking the box, I agree to the Terms & Conditions outlined.*

I Agree
Please attach: Flinders University Participation Agreement

Cancelof
Signature*

Clear
Should be Empty:

Medical Information

Bank Details (For uniform bond refund if required)

Additional Info