2024 Powerchair Football EOI

2024 Powerchair Football EOI

Are you interested in playing Powerchair Football in 2024? Fill out the form below.
Name*

First NameLast Name
Gender*

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

YesNo
What disability do you have?*

Muscular Dystrophy (any type)AmputeeCerebral PalsySpina BifidaParaplegicOther
Do you use or own a powerchair?*

YesNo
I wish to join as a/an*

AthleteCoachVolunteerReferee
What do you hope to get out of joining the Canberra Powerchair League?*

CompetitionPathways to National/International selectionSocialising and making new friendsVolunteeringOther
How did you hear about Powerchair football in Canberra?*

Capital Football websiteSocial mediaRadioFriends/FamilyTV newsOther
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