Wheelchair Rugby League Registration

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Please complete this form to register as a Participant for our Have A Go Wheelchair Rugby League Day on Monday 6th July 2006, at the Sportsdrome in Rototua.

No previous experience is necessary. It is going to be an epic event and we look forward to seeing you there!

Parafed Bay of Plenty, Rotorua Lakes Council, Warriors Community Foundation

Email *

Please provide your full name. *

Please provide your contact telephone number. *

Please advise an emergency contact name and contact number? *

Please advise where you are from? *

Eastern Bay of Plenty

Rotorua

Tauranga Central

Western Bay of Plenty

Other:

Required

Are you happy to have your photo taken and used for relevant social media? *

Yes

Depending on registration numbers there may be 2 time slots between 10am and 2pm, but this is to be confirmed. Please advise if you would prefer the first or second slot. *

First slot 10:15am – 11:45am (1.5 hours)

Second slot 12:30pm – 2:00pm (1.5 hours)

Would you like to receive updates from Parafed Bay of Plenty and the Warriors Community Foundation about Para Sport and other opportunities? (We may add you to a contact list for this purpose) *

Yes

Thank you for completing this form and we will be back in touch closer to the event with further information or you can email Jo jo@parafedbop.co.nz

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