Llew Rees Memorial Prize
Application Form
Name: ……………………………………………………………………………………………………………………………….
Home Address: ………………………………………………………………………………………………………………….
Bangor Address: ………………………………………………………………………………………………………………..
Mobile number: …………………………………………………………………………………………………………………
Email address: ……………………………………………………………………………………………………………………
Athletic Union membership number: …………………………………………………………………………………
Course and year of study: ………………………………………………………………………………………………….
Sport: ………………………………………………………………………………………………………………………………..
Are you a member of an AU Club? If so, which?
Please list your sporting achievements over the last 2 years, including the level you attained, representative honours (including national rankings, tournament/competition results etc.). Please include dates. Continue on a separate sheet if necessary.
What are the AU club’s successes over the last 12 months?
What have you done to raise the profile of Bangor University sport and what contributions have you made?
How would you benefit from the prize money?
Please provide your sport-related (AU Club and personal) goals over the next 12 months, along with details about how you will achieve your objectives.
Declaration: I declare that the details given in this application form are a true and accurate representation of my status and sporting achievements. If successful, I understand that my details may be used in University publicity unless I request otherwise.
Signature: ……………………………………………………….. Date: ………………………………………………………
Please indicate where you learned about The Llew Rees Memorial Prize: