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:
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (+61) 0000 000 000.
Email
example@example.com
Participant Name

First NameLast Name
Classification
Participant is
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (+61) 0000 000 000.
Parent/Guardian Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (+61) 0000 000 000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (+61) 0000 000 000.
Additional Information
Will you be flying to Brisbane for this event?
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?
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
$50.00 AUD

Total

$0.00 AUD
Should be Empty:

2022 Hells Bells Registration Form

Additional Information

Registration Fees:

Pay by credit card ONLY here