Please register your details so you can join in the fun of the AFL Blind come and try days, as a player or volunteer. We welcome everyone to come a try. Men and women, people with and without vision impairments and all skill levels. For more information please contact Tim Nield on tim.nield@afl.com.au or 0418 489 019.

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* 1. Full Name:

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* 2. Level of Vision:

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* 3. I'm registering as a:

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* 4. Gender:

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* 5. Age

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* 6. I will be attending the following come and try sessions:

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* 7. Postcode:

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* 8. Phone:

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* 9. Email:

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* 10. Do you have any fears about participating in the AFL BLind come and try sessions?

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* 11. Please answer this question if you are 18 years of age or over. Please select 'I am under 18 years of age', if question is not relevant. 
In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? (This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job).

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* 12. Please answer this question if you are 17 years of age or under. Please select 'I am  18 years of age or over', if question is not relevant. 
In the past week, on how many days have you done a total of 60 minutes or more of physical activity, which was enough to raise your breathing rate? (Physical activity is any activity that increases your heart rate and makes you get out of breath some of the time. Physical activity can be done in sports, playing with friends, or walking to school. Some examples of physical activity are running, brisk walking, rollerblading, biking, dancing, skateboarding, swimming, soccer, basketball, football and surfing. Don’t include your physical education class).

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* 13. On a scale of 0 – 10 (where 0 is not at all confident and 10 is extremely confident), how confident are you about being able to participate in physical activity on a regular basis?

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* 14. Where did you hear about the AFL Blind come and try sessions?

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* 15. Please list any other comments you would like us to know

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