2018 Victorian State Titles Registration Form
Welcome to the registration form for the 2018 Victorian State Titles. Please read through and complete each section carefully and as accurately as possible. This registration form covers all individuals participating in the tournament as athletes, spectators and tournament officials. There will be opportunities to edit your registration after submission. Directions of this can be found on the confirmation screen after a registration has been submitted. Each registration form covers one (1) individual only. To complete multiple registrations, an individual will need to resubmit the entire form which can also be done from the confirmation screen. All information gathered will be stored confidentially by the Victorian Goalball Association in accordance with the Victorian Goalball Association's privacy policy unless otherwise specified
General Information
First Name(s) *
Your answer
Last Name *
Your answer
Date of Birth *
Please type your answer
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Sex *
Contact Information
Street Address *
Your answer
Suburb/Town *
Your answer
State *
Postcode *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Emergency Contact Information
Contact Name *
Your answer
Phone *
Your answer
Relationship to Individual *
Your answer
Medical Information & Dietary Requirements
Please give details of any allergies or medical conditions the Victorian Goalball Association should be aware of
Your answer
Please give details of any medication you are taking
Your answer
Please give details of any dietary requirements you have
Your answer
Are you under the age of 18? *
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