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Brimbank Switch registration

 The Switch program is a multi week female only program for any woman who wants to get active in a fun and inclusive environment.
 Switch focuses on the fun and social benefits of Touch football, which enables an enjoyable and easy switch into social sport.
To be apart of this free program all you need to do is fill in the registration form below 

Come and Try 22nd of March. 
5pm- 6:00pm
Bon Thomas Reserve

Please note your non-identifiable data will be provided to LaTrobe University on behalf of VicHealth.

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* 1. First name

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* 2. Surname

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* 3. Email

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* 4. Phone number

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* 5. Gender

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* 6. Date of birth

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* 7. What is your street address?

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* 8. What is your postcode

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* 9. Which of the following best describes your current occupation?

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* 10. Other than a Medicare card, are you the holder of a health care card or a pensioner concession card? Health care cards are issued by Centrelink and are different to Medicare cards.

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* 11. Are you the parent or carer of any children in your household? This includes children over 18 years.

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* 12. Where were you born?

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