REGISTRATION FOR VICTORIAN ELECTRIC WHEELCHAIR SPORTS ASSOCIATION

Please complete this form to become a General Member of Victorian Electric Wheelchair Sports Association

· General Membership is $14.00 Adults/$6.00 Under 16's including a $2.00 joining fee for new members. These fees help VEWSA cover insurance costs.

· Volunteer General Memberships are free.

- Victorian Powerchair Sports League (VPSL) is $120.00 for the 2019/20 Season.

- Victorian Powerchair Premier League (VPPL) is $120.00 for the 2019 Season.

If you have any questions, please email luke.david@vewsa.org.au

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* 1. Applicant's contact details

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* 2. Email address

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* 3. Date of birth

Date / Time

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* 4. Membership category

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* 5. Name of disability (players only)

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* 6. Parent, advocate or emergency contact information

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* 7. By filling out this registration form, I also give consent to the publication of written information pertaining to me (excluding medical or health information) and to the publication of my personal image and performance results, for non-commercial educational, promotional and archival purposes for the sports.

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