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EVENTS
NEWS
TEAMS
- STANDINGS
3X3
ABOUT
- HISTORY
REGISTER
PHOTOS
VIDEOS

GOA OFFICIALS REGISTRATION FORM

EVENT NAME *

SECTION A – PERSONAL INFORMATION

Name (as in passport, include middle names) *

First

Middle

Last

Date of Birth *

Gender *

Male
Female

Marital Status *

Single
Married
Divorce
Widower

Nationality *

National ID Number *

Name of Father *

First

Last

Nationality of Father *

Name of Mother *

First

Last

Nationality of Mother *

Other Languages spoken:

Photo (Head shot photo on white background) *

Click or drag a file to this area to upload.

SECTION B – CONTACT INFORMATION

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Email *

Mobile Phone *

Home Phone

Work Phone

SECTION C – GUYANA PASSPORT INFORMATION

Passport Number *

Date of Issue *

Date of Expiry *

Place of Issue *

GUYANA Passport (Upload a copy of your Guyana Passport Bio page) *

Click or drag a file to this area to upload.

SECTION D – OTHER PASSPORT INFORMATION

Do you have a Non-Guyanese Passport *

Yes
No

Nationality of Passport *

Passport Number *

Date of Issue *

Date of Expiry *

Place of Issue *

Other Passport (Upload a copy of your other passport Bio page) *

Click or drag a file to this area to upload.

SECTION E – VISA INFORMATION

Are you currently in possession of a valid USA visa? *

Yes
No

USA Visa Number *

Date of Issue *

Date of Expiry *

Place of Issue *

Upload a copy of your USA visa *

Click or drag a file to this area to upload.

Have you ever been refused a USA visa? *

Yes
No

If yes, give details *

Have you ever been refused a visa from any other country?

Yes
No

If yes, what country? *

If yes, give details *

SECTION F – UNIFORM MEASUREMENTS

Polo Shirt Size *

S
M
L
XL
2XL
3XL

T-Shirt Size *

S
M
L
XL
2XL
3XL

Shorts Size *

S
M
L
XL
2XL
3XL

Track Suit Size *

S
M
L
XL
2XL
3XL

Dress Shirt Collar Size (in inches) *

Waist size (in inches): & Hip Measurements (Females) *

Chest size or Bust for Females: (in inches) *

Pants Length (waist to ankle, in inches) *

Pants Length (in seam, in inches) *

Shoe Size (US size – e.g. M 10 or W 8.5) *

SECTION G – MEDICAL INFORMATION

Height (in centimeters) *

Weight (in kilograms) *

Blood Type *

A
B
AB
O

Chronic Diseases (e.g. Asthma, Diabetes) *

Allergies *

Medications being taken *

Special Diet required (e.g. vegetarian) *

Dietary Supplements/Medications taken for sports performance *

Person to contact in case of emergency *

Relationship *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mobile Phone *

Home Phone

Work Phone

Confirmation *

I confirm that the Guyana Olympic Association has my approval to store the information provided on this form on their computer database.

Contact Info

91 Middle Street, Cummingburg,
Georgetown, Guyana

info@guyana.basketball

+592 660 2393