WYONG SHIRE COUNCIL SISTER CITY COMMITTEE2010417122446 by lindayy

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									                        WYONG SHIRE COUNCIL SISTER CITY COMMITTEE
                             AMBASSADOR APPLICATION FORM
Name
Address

Telephone number

Email

Date of Birth

Destination                     Tanabe City, Japan                 Southland District, New Zealand

                                Please delete the one not applicable
Preferred date for visit

Second choice of date
if first not available
Are you a Wyong Shire           Yes                                No
resident?
                                Please delete the one not applicable
Are you an Australian           Yes                                No
citizen?
                                Please delete the one not applicable
Area of interest
If insufficient space, please
include additional page




Expected benefits
If insufficient space, please
include additional page
Please explain briefly
why you feel you
should be offered a
scholarship
If insufficient space, please
include additional page




Please complete the form and send it to:

The Chairperson
Wyong Shire Sister City Committee
PO Box 20, Wyong NSW 2259
Email: maree.wheelahan@wyong.nsw.gov.au
Fax: 4351 2098

								
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