2021 Powerchair Football EOI

2021 Powerchair Football EOI

Are you interested in playing Powerchair Football in 2021? Fill out the form below.
Name *

First Name Last Name
Gender *

Male Female Other Prefer not to say
Age *
Contact Number *
Please enter a valid phone number.
Email *
example@example.com
Do you have a disability? *

Yes No
What disability do you have? *

Muscular Dystrophy (any type) Amputee Cerebral Palsy Spina Bifida Paraplegic Other
What is your shirt/jersey size? *
Do you use or own a powerchair? *

Yes No
I wish to join as a/an *

Athlete Coach Volunteer Sponsor Referee
What do you hope to get out of joining the Canberra Powerchair League? *

Competition Pathways to National/International selection Socialising and making new friends Volunteering Other
How did you hear about Powerchair football in Canberra? *

Capital Football website Social media Radio Friends/Family TV news Other
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