Get Involved with Powerchair Sports Victoria

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

For more information about Powerchair Sports Victoria, our sports or to discuss your suitability please contact info@psv.org.au

Your name? *

Your gender?

Male

Female

Prefer Not To Say

Other:

Clear selection

What is your preferred contact number? *

What is your preferred email address? *

What suburb do you live in? *

Your age? *

Have you previously experienced any other disability sports? *

If you own a powerchair, what model do you currently use?

Nature of Impairment/Disability:

I don't have a disability

Muscular Dystrophy (All types)

Cerebral Palsy

Brittle Bones

Spina Bifida

Prefer not to answer

Other:

Clear selection

I am interested in: *

Playing

Volunteering

Sponsoring

Coaching

Refereeing

Required

I accessed this expression of interest via: *

Powerchair Sports Victoria

Melbourne City FC

South Melbourne FC

Other:

How did you hear about us? *

Is there any information or questions you would like us to answer in particular?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy