2022 Hells Bells Registration Form

2022 Hells Bells Registration Form
Welcome to the Goalball State Championships for 2022! We have scheduled arrivals on the 15th and a possible technical session on that evening with competition on the Saturday and Sunday.

We can't wait to host you for this exciting event!

Queensland Goalball Championships, 15 - 17 July 2022
I am registering for:*

2022 Hells Bells Player2022 Hells Bells Coach2022 Hells Bells Referee
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Participant Name*

First NameLast Name
Classification*
Participant is*

Under 18Over 18
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Additional Information
Will you be flying to Brisbane for this event?*

YesNo
If you are flying to Brisbane for this event you will be contacted closer to the event date to organise transportation.
Do you have any allergies, dietary requirements or current medical conditions?*

YesNo
Please specify
Registration Fees:

2022 Hells Bells Player Registration - $50

PAYMENT OPTIONS

CREDIT CARD

To pay your registration fee with Credit Card (via PayPal) please complete the payment section below and follow instructions.

BANK DEPOSIT:

Step 1. Transfer full registration fee amount to Sporting Wheelies and Disabled Association account:

Bank: Westpac BSB No: 034-143 Account No: 112275

Step 2. Add in Reference section: "Name" + Hells Bells 22
Pay by credit card ONLY here
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2022 Hells Bells Player Registration
$50.00AUD

Total

$0.00AUD
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2022 Hells Bells Registration Form

Additional Information

Registration Fees: