2022 CLASSICS Online Entry Form

Goalball Queensland State Titles (Hells Bells) 2023 - Player Registration
Date: 5th & 6th of August 2023

Location: Sporting Wheelies Para Clubhouse, 2 Kilroe Street, Milton QLD 4064

Registration close: 14th July 2023
Individual Player
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Mobile Phone No.*
E-mail*
Classification*
Please select from drop-down menu
Payment
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Player registration$100.00AUD

SW Social Sport Discounted player registration$80.00AUD
(Applicable only to those currently registered in a Sporting Wheelies 2023 Goalball Social Sports Program)

Total $0.00AUD
Should be Empty:

Goalball Queensland State Titles (Hells Bells) 2023 - Player Registration