Australian Goalball Referees - New Member Application Form

Registration Details

Registration Type:

Package

Contact Details

First name: Surname: Email Address: Phone (MOB): Phone (H):

Gender:

Date of Birth:

Address:

Street Number and Street Name:

Suburb:

Post Code:

State:

Other Info:

Guide Dog:

Wine Tour

Attending Referee Course Wednesday afternoon:

Emergency Contact - Parent or Guardian

First name: Surname: Email Address: Mobile Number:
Dietary Requirements: (Saturday Night Meal, Sunday Presentation Lunch).
Medical Conditions: (Are there any medical conditions, allergies or medication that we need to know about).
Comments:

Flight Details:

Do you require Airport Transfers?

By clicking Register Now, you agree to the Player Terms and Conditions of Entry set out by the Goalball Australia (Local Organising Committee).

2019 Australian Goalball Championships

Individual Participation Form