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Level Playing Field 'Wales Forum' registration form for fans
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1.
First name
(Required.)
*
2.
Last name
(Required.)
*
3.
Contact e-mail
(Required.)
4.
Contact phone number
5.
Please let us know if you have any access requirements (e.g. interpreter, large print text, subtitles)
6.
Will you be bringing a companion/PA?
Yes
No
7.
Which club do you support?
8.
Are you a member of your club's Disabled Supporters Association (DSA)?
Yes
No
9.
Are you a member of any other supporter organisations? (e.g. Supporter's Trust)
Yes
No
10.
Do you or your companion have any dietary requirements, including any allergies? (please list all)
11.
Do you require parking?
Yes (accessible parking)
Yes (general parking)
No
12.
If you require parking, please provide your vehicle registration number
13.
You can sign up to
Level Playing Field's fan membership
, free of charge, to receive our fan newsletter. Would you like to join?
Yes please, sign me up.
Maybe, please send me more details.
No thanks, I'm not interested at this time.
I'm already a member.