LJBC Sport Champions Application

First Name

Last Name

Current year level or year of graduation

Email Address

Phone

Sport relevant to this application

Please select one or more:

State RepresentationNational Representation

Year of achievement

Country/State achievement took place

Your achievement in this sport

*Important - Please note that all applications and selections are subject to approval by the LJBC Sport Committee

Please submit a photo / documentation to support your achievement

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