ࡱ> OQN#` mbjbj5G5G 8DW-W-84P (:HHh{{{` b b b b b b $ "hq$X w{ Hh @@@Hh` @` @@@H  Po=1Y`@ L 0 @$0$@$@{r@\{{{ d{{{  d Paralympics New Zealand Personal Details Form Instructions: This PNZ Form is to capture your personal details, please type your answer immediately after the prompts. If there is a Yes/No answer please delete as appropriate. Please complete this in electronic format and email back to  HYPERLINK "mailto:info@paralympics.org.nz" info@paralympics.org.nz Many Thanks. PERSONAL DETAILS First Name: Surname: Address: Male/Female: Date of Birth: Tel (Home): Tel (Work): Mobile: Fax: E-Mail: Occupation: Nationality: Place of Birth: Dietary requirement e.g. Vegetarian: NEXT OF KIN DETAILS 2 Contact Person Please First Person Full Name: Relationship: Address: Tel (Home): Tel (Work): Fax: Mobile: Email: Second Person Full Name: Relationship: Address: Tel (Home): Tel (Work): Fax: Mobile: Email: LAWYER DETAILS Full Name: Relationship: Address: Tel (Home): Tel (Work): Fax: Mobile: Email: PERSONAL PASSPORT DETAILS (please include photocopy of passport) Full Name (as on Passport): Passport Number: Passport Expiry Date (DD/MM/YY): Is your Passport Issued in NZ: If not NZ, please state Country: DISABILITY Impairment: Classification: Do you have Electric Wheelchair: Do you have Manual Wheelchair: Are you Ambulant: Are you Blind: If yes to any of the above, please state the type of Assistance Required: MEDICAL PRACTITIONER INFORMATION Full Name (Mr/Ms/Mrs/Dr): Name of Medical Office/Centre: Fax: Tel (Work): Mobile:      FILENAME \p \\General\SharedDocs\OPERATIONS\Forms and Templates\Events Related\Personal Details Form\Personal Details Form word doc WC010207.doc Updated on  DATE \@ "d/MM/yyyy" 26/02/2007  PAGE 1 -.:;<ou  0 G I J K b c d e r ˼鰡o^VLh&CJmH sH h&mH sH  hMhJ0JCJaJmH sH +jhMhJCJUaJmH sH hJCJaJmH sH jhJCJUaJmH sH hJhJCJaJmH sH hzfCJaJmH sH h5haWCJaJmH sH h5h(CJaJmH sH h5h\%)CJaJmH sH h5hzfCJaJmH sH h&h5.e r U$ Ə/w| # s 1nM{8s0l"E$$&/'((+*{*++(-x-./50059=AEIMQU7$8$H$a$gd\%)gd5gdaWgd5 l       & 6 8 = e f ӽӽӽӽӽӽӽӽӽӽӽӽӧ{sk_h&CJaJmH sH h*mH sH hmH sH +hB*CJOJQJ^JaJmH phsH +hSuB*CJOJQJ^JaJmH phsH +hMB*CJOJQJ^JaJmH phsH +h&B*CJOJQJ^JaJmH phsH +haWB*CJOJQJ^JaJmH phsH +h ;[B*CJOJQJ^JaJmH phsH # @U$ Ə/w| # s 1nM{8s0l"E$$&/'((+*{*++(-x-./50059=AEIMQU7$8$H$a$gd\%)j$ ƹ=wk| # s 1O/nM{8s0x l"E$$&/'((+*{*++(-x-./50012T33459=AEIMQU7$8$H$a$gd\%) 3h$ ƶh$ ƶjh>U+h5B*CJOJQJ^JaJmH phsH 1hh&B*CJOJQJ^JaJmH phsH +h*B*CJOJQJ^JaJmH phsH  0...h$ ƶ*B*phHH Jvp Balloon TextCJOJQJ^JaJ4"4 xgHeader  !4 @24 xgFooter  !p!Bp 5Style Heading 2 + Justified$a$CJPJ^JaJ.)@Q. ! Page NumbermD.er8fs~ ,7ENZfksz (IT`p=Wv{1jn000000r0r0r0r0r0r0r0r0r0r0r0r0r0r0(080f0f0f0f0f0f0f0f(080000000000000000000z0z0z0z0z00I0I0I0I0I0I0I000000h00@000@000@000@000@0@000| .er8f~ 7fksz (IT`p=W{nh00h00j00j00j00j00.j00j00000000j000.j00j00j000000j00.j00j0000j00.j00j000000004!000000 00000000000000000000P!000T  f m  s  N ( p  v m  !l JbmX !l,R$JďhڒP#ޑ@0(  B S  ?m  k|ϱ k2 kk<k}k}k|kMk\^kkkkn  qqn 8 *urn:schemas-microsoft-com:office:smarttagsCity9 *urn:schemas-microsoft-com:office:smarttagsplace < ceijpNQ0<^_ikncd$'|0<^_ikn33333d7T^_iknckn/.cF!Y^&\%),*-BJNKWKaW ;[zfxg|jJvp{sSufv{^~W*H Rh>T!5Y->ML>Jiu-pLn\vm( .8{n U@ ˜L{m@UnknownGz Times New Roman5Symbol3& z Arial;SimSun[SO5& zaTahoma"1hXӧfӲ&Ӳ& A  !nx4dc*+2QHX ? {s2www Wade Chang Wade ChangOh+'0  8 D P \hpxwww Wade Chang Normal.dot Wade Chang11Microsoft Office Word@Ɣ @jW1Y@PPI@<1Y՜.+,D՜.+,D hp  Paralympics New Zealand  www Title 8@ _PID_HLINKSAx4Omailto:info@paralympics.org.nz-   !"$%&'()*,-./0123456789:;<=?@ABCDEGHIJKLMPRoot Entry F=1YRData #1Table+$WordDocument8DSummaryInformation(>DocumentSummaryInformation8FCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q