Provincial Convenor Application Form

Contact Information

Name*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Phone

Email*

Enter Email Confirm Email

District*

Sport Background

What Sport are you interested in being the Provincial Convenor for?*

Please select which sport you are most interested in being the Provincial Convenor for.

Is there an alternate or second Sport you are interested in being the Provincial Convenor for?

Please indicate if there is a second sport you are interested in being the Provincial Convenor for.

List your current SOO positions and coaching duties:

List any past SOO or Generic Sport positions you have held

Briefly describe any competition hosting experience you have

Please describe any notable coaching/ competition hosting accomplishments:

Certifications and Training

NCCP Certification Number*

NCCP Transcript*

Max. file size: 512 MB.

Please let us know why you would like to hold a Provincial Convenor position and what you hope to accomplish during your term if you are selected

References

Name- Reference #1

First Last

Phone

Email

Please list the nature of your relationship with this reference

Name- Reference #2

First Last

Phone

Email

Please list the nature of your relationship with this reference

Provincial Convenor Application Form