RTA - Revert to previous phase

First Name

Surname

Club Name

Region

Role in Club

Chairperson

Club Safeguarding Officer

COVID-19 Coordinator

Coach

Volunteer

Secretary

Membership Officer

Treasurer

Other…

Email Address

Confirm email

Phone Number

Single Sport Club

Multi Sport Club

Sport

Revert Date

Sports

Please only select the sport which you are reverting to previous phase

Sport	Revert Date
Sport	Revert Date
Sport	Revert Date

more sports

I confirm that our club is moving from:

1. Orientation Phase to Stay at Home

2. Reactivation Phase to Orientation Phase

3. Reactivation Phase to Stay at Home Phase