Referees Statement Question Title * 1. Name of Applicant Question Title * 2. Referee's Details Name Address Town/City County Postcode Telephone Number Mobile Number Email Address Sport Club Relationship to the applicant I confirm that I know this representative/organisation and their work for Sport in the City of Worcester. I have read this application and support the request for award. I would be willing to talk about the benefit of any successful award to the representative/organisation and provide a brief written report if required. Question Title * 3. Supporting Statement Question Title * 4. Declaration Signed Date Done