REGISTRATION FOR POWERCHAIR SPORTS VICTORIA

Please complete this form to become a General Member of POWERCHAIR SPORTS VICTORIA

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

· Volunteer General Memberships are free.

· Playing fees are $120.00 per season.

· Organisation Memberships are $35.00

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

Question Title

* 1. Applicant's contact details

Question Title

* 2. Email address

Question Title

* 3. Date of birth

Date

Question Title

* 4. Membership category

Question Title

* 5. Name of disability (players only)

Question Title

* 6. Parent, advocate or emergency contact information

Question Title

* 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.

T