01/2016 Appeal Form Date: Event: Venue: Event Number: Discipline

Appeal Form
In accordance with IAAF & Athletics New Zealand By-Laws, appeals to the jury must be accompanied with the
relevant fee as per the Event Rules. Protests must be made to the Referee within 30 minutes of the results
being posted or announced. Appeals must be made within 30 minutes of the Referee’s decision being made.
Date:
Event:
Venue:
Event Number:
Discipline:
Grade:
Appeal lodged by:
M / F
Relationship to Athlete:
Contact Phone Number:
Appeal lodged on behalf of:
Competition Number:
Team / Club / Affiliation:
Referee spoken to:
Time of protest to Referee:
Referee’s ruling:
Rule/s alleged to have been contravened:
Grounds for lodging appeal to Jury
Signature of Appellant:
Office Use Only
Fee received:
$
Date:
Time results posted:
Time appeal lodged:
Time protest lodged:
Jury Decision
Chairman Signature:
TIC Notified:
Secretary Signature:
Time:
Date:
By:
Competition Director Notified: Time:
Date:
By:
Appellant Notified:
Time:
Date:
By:
Results / Secretary Notified:
Time:
Date:
By:
01/2016