Elite Athlete Gold Card Scheme

Elite Athlete Gold Card Scheme

Application Form
Personal Details
Name*

First NameLast Name
Date of Birth

MonthDayYear
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload a passport type photograph (head and shoulders)*

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National Governing Body of Sport

Details
Your Sport*
National Governing Body of Sport (NGB) Name*
NGB Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NGB Contact Person *

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Your Ranking

Please provide details of what rank you are in your sport e.g,. 3rd in Northern Ireland at Senior level in Athletics or currently a member of the Irish Basketball team etc...
Details of forthcoming Events / Competition in the next 12months

Please provide details any forthcoming competitions and events over the next 12 months, that you have been selected for, or, the Governing Body of Sport is preparing you to participate in. These events must be at National level.
Competition Details e.g., location, date etc*
Competition Details e.g., location, date etc
Competition Details e.g., location, date etc
NGB Letter
It is essential that you provide us with a letter from your National Governing Body of Sport supporting your Elite Gold Card Application.

This Governing Body letter must include the following information:
- Name of the contact person within your Governing Body who we can contact if required.
- Confirmation that you are ranked in the top ten or have that you are currenly a member of a national team.
- Details of any events / competitions taking place in the next 12 months, that you have been selected to compete in or are earmarked to compete in.
- Details of the level of competition ie. junior, senior, veterans, etc.
File Upload*

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Facilities

If your application is successful, please can you indicate below by ticking the appropriate box, the facilities that you would wish to use.
Bawnacre Centre, Irvinestown - Fitness SuiteCastle Park Leisure Centre, Lisnaskea - Fitness SuiteFermanagh Lakeland Forum - Fitness SuiteFermanagh Lakeland Forum - Swimming PoolFermanagh Lakeland Forum - Athletics TrackOmagh Leisure Complex - Fitness SuiteOmagh Leisure Complex - Swimming PoolOmagh Leisure Complex - Athletics Track
Data Protection

In accordance with the Data Protection Act (as amended from time to time), Fermanagh and Omagh District Council has a duty to protect any information we hold on you. The information you provide on this form will only be used for the purpose of Elite Athlete Gold Card Scheme and will not be shared with any third party unless law or regulation compels such a disclosure. For further information on how we hold your information, please visit the Privacy section on the Council website HERE
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Elite Athlete Gold Card Scheme

Personal Details

National Governing Body of Sport

Your Ranking

Details of forthcoming Events / Competition in the next 12months

NGB Letter

Facilities