2024 Powerchair Football EOI
Are you interested in playing Powerchair Football in 2024? 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.
Format: (000) 000-0000.
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
Do you use or own a powerchair?
*
Yes
No
I wish to join as a/an
*
Athlete
Coach
Volunteer
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
Submit
Should be Empty: