Application Form (Age 16 to 23 years ONLY)
|
Application fee will be US $15.00 ( Government taxes included )
Multiple applications possible
|
|
|
Application Details |
|
|
First Name
|
|
Middle Name
|
|
Last Name
|
|
|
Gender
|
|
|
Age
|
|
Date of birth
|
Country of Birth
|
|
Level of Education Completed
|
|
Address 1
|
|
|
Address 2
|
|
|
Suburb
|
|
City
|
|
|
State
|
|
Post / Zip code
|
|
Country
|
|
|
Phone No
|
|
Mobile
|
|
Fax
|
|
|
Email Id
|
|
Confirm Email
|
|
|
|
Parent's Details
|
|
|
Parent's consent to apply
|
|
|
Mother's First Name
|
Father's First Name
|
|
Address 1
|
|
|
Address 2
|
|
|
Suburb
|
|
City
|
|
|
State
|
|
Post / Zip code
|
|
Country
|
|
|
Phone No
|
|
Mobile
|
|
Fax
|
|
|
Email Address
|
Confirm Email Address
|
|
|
Applicant's Personal information
|
|
|
1. Are you involved in sporting activity?
|
|
|
2. What is your prefferred sporting activity?
|
|
|
3. Have you had any sporting injury in the past or now?
|
|
|
4. Have you experienced cold climate?
|
|
|
5. Are you a fit person and interested in outdoor activities?
|
|
|
6. Are your parents fit & healthy?
|
|
|
|
|
|
Note: Any incomplete or misleading information will not
be accepted and application fee will not be returned.
|
|
|
|
For further details please visit our site:
www.antarcticchallenge.com
|
|