Join

First Name *

Surname *

Address *

Suburb

City

Postcode

Phone (home)

Phone (mobile)

Email *

Occupation/School

Date of Birth *

Disability *

Mobility Aid Used

Wheelchair

Electric

Manual

Sticks

Crutches

Tick any sport you are interested in participating in

Athletics

Boccia

Cycling

Swimming

Youth Group

Wheelchair Basketball

Wheelchair Rugby

Other

Sports Level

Recreation

Competition

If you are paying for a Family Subscription, please name family members who will be included in this fee

First Name(s)

Surname(s)

Phone

Email

Subscription

Single $30.00

Family $40.00

Deposits can be made electronically into the dsport bank.

Please identify payment by using your initial and surname (eg John Smith) when paying online.